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Irinotecan, vincristine, cisplatin, cyclophosphamide, and etoposide for refractory or relapsed medulloblastoma/PNET in pediatric patients

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Abstract

Purpose

The treatment outcome of pediatric refractory or relapsed brain tumor is very dismal, and effective salvage chemotherapy is not established. The combination of irinotecan, vincristine, cisplatin, cyclophosphamide, and etoposide was administered to pediatric patients with refractory or relapsed brain tumors as a salvage treatment at our institution.

Methods

The combination regimen was administered since June 2006 and consisted of irinotecan (300 mg/m2, d0), vincristine (2 mg/m2, d0), cisplatin (60 mg/m2, d0), cyclophosphamide (1,000 mg/m2, d1), and etoposide (100 mg/m2/day, d0–2). Patients could concurrently receive radiotherapy, surgery, and/or high-dose chemotherapy and stem cell rescue. The medical records of all patients were retrospectively analyzed.

Results

Thirteen patients with refractory or relapsed brain tumor were included (medulloblastoma, n = 12; central nervous system primitive neuroectodermal tumor, n = 1). Median time from diagnosis to this combination chemotherapy was 30 months (range, 3–111 months), and median cycle administered was four cycles (range 1–22 cycles). Objective tumor response at the end of chemotherapy was 38.5 % including three patients with complete response and two with partial response. One patient showed complete response and achieved long-term survival with this combination chemotherapy, and two patients achieved long-term survival with multimodality treatments. There was no grade III or IV toxicity related to this combination chemotherapy except for thrombocytopenia and neutropenia.

Conclusions

The combination of irinotecan, vincristine, cisplatin, cyclophosphamide, and etoposide may produce objective responses in pediatric patients with refractory or relapsed medulloblastoma or primitive neuroectodermal tumor.

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Acknowledgments

This study was supported by grants from the National R&D Program for Cancer Control, Ministry for Health & Welfare, Republic of Korea (0520300) and from Seoul National University Hospital (grant no. 30-2010-0130).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyery Kim, Hyoung Jin Kang, Ji Won Lee, June Dong Park, Kyung Duk Park, Hee Young Shin & Hyo Seop Ahn

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyery Kim, Hyoung Jin Kang, Ji Won Lee, Kyung Duk Park, Hee Young Shin & Hyo Seop Ahn

  3. Department of Pediatrics, Seoul National University Boramae Hospital, Seoul, Republic of Korea

    Hyery Kim

  4. Department of Pediatrics, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea

    Hee Young Shin

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  1. Hyery Kim
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Correspondence to Hee Young Shin.

Additional information

Hyery Kim and Hyoung Jin Kang contributed equally to this work.

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Kim, H., Kang, H.J., Lee, J.W. et al. Irinotecan, vincristine, cisplatin, cyclophosphamide, and etoposide for refractory or relapsed medulloblastoma/PNET in pediatric patients. Childs Nerv Syst 29, 1851–1858 (2013). https://doi.org/10.1007/s00381-013-2163-z

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