Rodríguez-Galindo Carlos, Daw Najat C, Kaste Sue C, Meyer William H, Dome Jeffrey S, Pappo Alberto S, Rao Bhaskar N, Pratt Charles B
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
J Pediatr Hematol Oncol. 2002 May;24(4):250-5. doi: 10.1097/00043426-200205000-00006.
Standard multiagent chemotherapy for osteosarcoma may include platinum compounds, doxorubicin, and high-dose methotrexate. By identifying new chemotherapeutic strategies, the outcome of these patients can be improved and the toxicity of treatment regimens decreased.
The authors evaluated the activity of the combination of cyclophosphamide (500 mg/m2 per day for 5 days) and etoposide (100 mg/m2 per day for 5 days) given with granulocyte colony-stimulating factor (G-CSF) to children with osteosarcoma unresponsive to conventional treatment.
Fourteen patients with refractory osteosarcoma were treated with this combination. Twelve patients had been previously treated with a multiagent regimen that included carboplatin, ifosfamide, methotrexate, and doxorubicin. Seven of 11 evaluable patients had a poor histologic response in their primary tumor at the time of definitive surgery (Huvos grade 1 or 2). Sites of relapse included lung, bone, and brain. A total of 47 courses were given. An overall response rate of 28.5% was achieved. A complete response was obtained in one patient (7.1%), a partial response was obtained in three patients (21.4%), and stable disease for 1 to 4 months was achieved in five patients (35.7%). Five patients (35.7%) had progressive disease. Grade 4 neutropenia was the primary form of toxicity observed; the median duration of absolute neurophil count less than 500/microL was 4 days.
The combination of cyclophosphamide and etoposide resulted in a response rate of 28.5% in patients with refractory or relapsed osteosarcoma, and its incorporation into front-line therapies deserves further evaluation.
骨肉瘤的标准多药化疗可能包括铂类化合物、阿霉素和大剂量甲氨蝶呤。通过确定新的化疗策略，可以改善这些患者的治疗结果，并降低治疗方案的毒性。
作者评估了环磷酰胺（每天500mg/m²，共5天）和依托泊苷（每天100mg/m²，共5天）联合粒细胞集落刺激因子（G-CSF）对常规治疗无效的骨肉瘤患儿的疗效。
14例难治性骨肉瘤患者接受了该联合治疗。12例患者之前接受过包括卡铂、异环磷酰胺、甲氨蝶呤和阿霉素的多药方案治疗。11例可评估患者中有7例在确定性手术时原发肿瘤组织学反应较差（胡沃斯1级或2级）。复发部位包括肺、骨和脑。共进行了47个疗程的治疗。总缓解率为28.5%。1例患者（7.1%）获得完全缓解，3例患者（21.4%）获得部分缓解，5例患者（35.7%）病情稳定1至4个月。5例患者（35.7%）病情进展。4级中性粒细胞减少是观察到的主要毒性形式；绝对中性粒细胞计数低于500/μL的中位持续时间为4天。
环磷酰胺和依托泊苷联合治疗难治性或复发性骨肉瘤患者的缓解率为28.5%，将其纳入一线治疗值得进一步评估。
