BACKGROUND: 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. METHODS: Treatment comprised ifosfamide (2000 mg/m(2) daily for 5 days), carboplatin (500 mg/m(2) daily for 2 days), and etoposide (100 mg/m(2) 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 (123) I-metaiodobenzylguanidine findings). Publications that were informative about ICE for NB were reviewed. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: Treatment comprised ifosfamide (2000 mg/m(2) daily for 5 days), carboplatin (500 mg/m(2) daily for 2 days), and etoposide (100 mg/m(2) 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 (123) I-metaiodobenzylguanidine findings). Publications that were informative about ICE for NB were reviewed. RESULTS: 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. CONCLUSIONS: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.
Authors: Brian H Kushner; Irina Ostrovnaya; Irene Y Cheung; Deborah Kuk; Kim Kramer; Shakeel Modak; Karima Yataghene; N K Cheung Journal: Oncoimmunology Date: 2015-05-22 Impact factor: 8.110
Authors: Rajen Mody; Arlene Naranjo; Collin Van Ryn; Alice L Yu; Wendy B London; Barry L Shulkin; Marguerite T Parisi; Sabah-E-Noor Servaes; Mitchell B Diccianni; Paul M Sondel; Julia G Bender; John M Maris; Julie R Park; Rochelle Bagatell Journal: Lancet Oncol Date: 2017-05-23 Impact factor: 41.316
Authors: Brian H Kushner; Irene Y Cheung; Shakeel Modak; Kim Kramer; Govind Ragupathi; Nai-Kong V Cheung Journal: Clin Cancer Res Date: 2014-02-11 Impact factor: 12.531
Authors: Brian H Kushner; Shakeel Modak; Kim Kramer; Michael P LaQuaglia; Karima Yataghene; Ellen M Basu; Stephen S Roberts; Nai-Kong V Cheung Journal: Cancer Date: 2014-04-01 Impact factor: 6.860
Authors: Sara M Federico; M Beth McCarville; Barry L Shulkin; Paul M Sondel; Jacquelyn A Hank; Paul Hutson; Michael Meagher; Aaron Shafer; Catherine Y Ng; Wing Leung; William E Janssen; Jianrong Wu; Shenghua Mao; Rachel C Brennan; Victor M Santana; Alberto S Pappo; Wayne L Furman Journal: Clin Cancer Res Date: 2017-09-22 Impact factor: 12.531