Department of Pediatrics, University of California at San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California, USA.
Cancer. 2011 Sep 15;117(18):4286-93. doi: 10.1002/cncr.25987. Epub 2011 Mar 8.
Adolescent and adult patients with neuroblastoma appear to have a more indolent disease course but a lower survival rate compared with their younger counterparts. The majority of neuroblastoma tumors specifically accumulate the radiolabeled norepinephrine analogue iodine-131-metaiodobenzylguanidine ((131) I-MIBG). Therefore, (131) I-MIBG has become increasingly used as targeted radiotherapy for patients with recurrent or refractory neuroblastoma. The objective of the current study was to characterize the toxicity and activity of this therapy in older patients.
The authors performed a retrospective analysis of 39 consecutive patients aged ≥10 years with recurrent or refractory neuroblastoma who were treated with (131) I-MIBG monotherapy at the University of California at San Francisco under phase 1, phase 2, and compassionate access protocols.
Sixteen patients were aged ≥18 years at the time of MIBG treatment initiation, whereas 23 patients were ages 10 to 17 years. The median cumulative administered dose of (131) I-MIBG was 17.8 millicuries (mCi)/kg. The majority of treatments led to grade 3 or 4 hematologic toxicities (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 3]) that were similar in frequency among age strata. Three patients subsequently developed a hematologic malignancy or myelodysplasia. The overall rate of complete plus partial response was 46%. Patients aged ≥18 years at the time of first MIBG treatment had a significantly higher response rate compared with patients ages 10 to 17 years (56% vs 39%; P = .023). The median overall survival was 23 months with a trend toward longer overall survival for the subgroup of patients aged ≥18 years (P = .12).
The findings of the current study suggest that (131) I-MIBG is a highly effective salvage agent for adolescents and adults with neuroblastoma.
与年轻患者相比，青少年和成年神经母细胞瘤患者的疾病进程似乎更为惰性，但存活率较低。大多数神经母细胞瘤肿瘤特别积累放射性标记的去甲肾上腺素类似物碘-131-间碘苄胍（131I-MIBG）。因此，131I-MIBG 已越来越多地被用作复发性或难治性神经母细胞瘤患者的靶向放疗。本研究的目的是描述该疗法在老年患者中的毒性和疗效。
作者对在加利福尼亚大学旧金山分校接受 131I-MIBG 单药治疗的 39 例复发性或难治性神经母细胞瘤≥10 岁的连续患者进行了回顾性分析，这些患者参加了 1 期、2 期和同情准入方案。
16 例患者在开始 MIBG 治疗时年龄≥18 岁，而 23 例患者年龄为 10 至 17 岁。131I-MIBG 的累积给药中位数为 17.8 毫居里（mCi）/kg。大多数治疗导致 3 级或 4 级血液学毒性（根据国家癌症研究所不良事件常见术语标准[第 3 版]进行分级），在年龄组之间的频率相似。有 3 例随后发生血液系统恶性肿瘤或骨髓增生异常。完全缓解加部分缓解的总发生率为 46%。首次 MIBG 治疗时年龄≥18 岁的患者的缓解率明显高于 10 至 17 岁的患者（56%比 39%；P=0.023）。中位总生存期为 23 个月，≥18 岁亚组的总生存期有延长趋势（P=0.12）。
本研究的结果表明，131I-MIBG 是神经母细胞瘤青少年和成年患者的一种非常有效的挽救治疗药物。
