Ifosfamide, carboplatin, and etoposide for neuroblastoma
A high-dose salvage regimen and review of the literature
Version of Record online: 5 SEP 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 3, pages 665–671, 1 February 2013
How to Cite
Kushner, B. H., Modak, S., Kramer, K., Basu, E. M., Roberts, S. S. and Cheung, N.-K. V. (2013), Ifosfamide, carboplatin, and etoposide for neuroblastoma. Cancer, 119: 665–671. doi: 10.1002/cncr.27783
- Issue online: 22 JAN 2013
- Version of Record online: 5 SEP 2012
- Manuscript Accepted: 13 JUL 2012
- Manuscript Revised: 5 JUL 2012
- Manuscript Received: 24 MAY 2012
- novel therapeutics;
- salvage therapy;
- peripheral blood stem cells
The authors report a retrospective analysis of high-dose ifosfamide, carboplatin, and etoposide (HD-ICE) for patients with refractory or relapsed neuroblastoma (NB). A major reason for using this regimen was the long time since patients received previous treatment with a platinum compound. The authors also summarized the published experience on ICE in patients with NB.
Treatment comprised ifosfamide (2000 mg/m2 daily for 5 days), carboplatin (500 mg/m2 daily for 2 days), and etoposide (100 mg/m2 daily for 5 days). Patients who had poor hematologic reserve (platelet count <100,000/μL) from previous therapy received peripheral blood stem cells (PBSCs) after HD-ICE. Disease status before and after HD-ICE was defined according to International Neuroblastoma Response Criteria (expanded to include 123I-metaiodobenzylguanidine findings). Publications that were informative about ICE for NB were reviewed.
Seventy-four patients received 92 cycles of ICE, including 37 patients who received PBSC rescue. Grade 3 toxicities were rare: 1–3 patients had encephalopathy, mucositis, or gastroenteritis. Bacteremia was documented in 24 of 92 cycles (26%). The absolute neutrophil count reached 500/μL on day 17–30 (median, day 22) in patients who had satisfactory hematologic reserve. Disease regressions (major and minor responses) were achieved by 14 of 17 patients (82%) with a new relapse, 13 of 26 patients (50%) with refractory NB, and 12 of 34 patients (35%) who were treated for progressive disease during chemotherapy (P = .005). In the literature, patients received ICE at lower dosages and achieved major response rates >36% in phase 1 and 2 studies (in which less comprehensive staging evaluations were used) that involved resistant NB and >70% in induction for newly diagnosed NB.
HD-ICE is appealing as salvage treatment or consolidative therapy because of its anti-NB activity and the low risk of major nonhematologic toxicity. PBSC support is unnecessary for patients who had intact hematologic reserve. Cancer 2013. © 2012 American Cancer Society.