Departments of Pediatric Hematology, Immunology and Oncology.
Metronomics Global Health Initiative.
J Pediatr Hematol Oncol. 2021 Jul 1;43(5):e630-e634. doi: 10.1097/MPH.0000000000002002.
Pediatric low-grade glioma (pLGG) represents the most common brain tumor in childhood. Previous studies have reported that a therapeutic strategy on the basis of the association of bevacizumab alone (B) or in combination with irinotecan (BI) could produce rapid tumor response and clinical improvement in children with pLGG. Nevertheless, a majority of patients relapses shortly (median, 5 mo) after stopping B or BI treatment. We proposed metronomic maintenance with weekly vinblastine added after a 6 months induction of B/BI to prevent early relapse.
Monocentric retrospective analysis of a patient with pLGG treated with B or BI for 6 months followed by a 12-month maintenance with weekly vinblastine (6 mg/m²) from October 2012 to September 2019 in a single institution.
In total, 18 patients (7 males and 11 females) were identified. Because of progression during the B or BI induction 2/18 children were excluded. In total, 16 patients were analyzed with a median age of 10 years (range, 4 to 16 y). A total of 13 patients received BI and 3 patients received B alone. The mean duration of induction was 6.2 months (range, 2 to 12 mo). After induction 5/16 patients had a partial radiologic response, 11/16 patients had stable disease. All patients started maintenance (median duration, 12 mo; range, 3 to 12 mo). With a median follow-up of 3.9 years after the end of B or BI (range, 11 mo to 7.2 y), 15/16 patients were alive and 9/16 patients were progression-free. Seven of 16 children progressed with a median time to progression of 23 months (ranges, 5 to 39 mo). Three of 16 (18%) children progressed during vinblastine maintenance and 4/16 (25%) patients after the end of maintenance. After the total duration of treatment, clinical improvement was noted in 4 patients, 9 patients had stable symptoms, and only 3 patients progressed. One and 2-year event-free survival were, respectively, 81.2% and 56.2%. Two-year overall survival was 93.7%.
We report here, the potential benefit and the improvement of progression-free survival by adding metronomic maintenance with weekly vinblastine after initial induction with B or BI in children with low-grade glioma.
小儿低级别胶质瘤（pLGG）是儿童中最常见的脑肿瘤。先前的研究报告称，贝伐单抗单药（B）或联合伊立替康（BI）的治疗策略可在儿童 pLGG 中产生快速的肿瘤反应和临床改善。然而，大多数患者在停止 B 或 BI 治疗后不久（中位时间为 5 个月）复发。我们提出在 B/BI 诱导 6 个月后每周给予长春新碱维持治疗，以预防早期复发。
2012 年 10 月至 2019 年 9 月，在单一机构中对接受 B 或 BI 治疗 6 个月后接受每周长春新碱（6mg/m²）维持治疗 12 个月的 1 例 pLGG 患儿进行单中心回顾性分析。
共发现 18 例患儿（7 名男性和 11 名女性）。由于 B 或 BI 诱导过程中出现进展，有 2/18 名患儿被排除。共有 16 例患儿进行了分析，中位年龄为 10 岁（范围为 4 至 16 岁）。13 例患儿接受 BI 治疗，3 例患儿接受 B 单药治疗。诱导的平均持续时间为 6.2 个月（范围为 2 至 12 个月）。诱导后，5/16 例患者部分影像学反应，11/16 例患者疾病稳定。所有患者均开始维持治疗（中位持续时间为 12 个月；范围为 3 至 12 个月）。在 B 或 BI 结束后中位随访 3.9 年（范围为 11 个月至 7.2 年）时，16 例患儿中有 15 例存活，9 例无进展。16 例患儿中有 7 例（7/16）进展，中位进展时间为 23 个月（范围为 5 至 39 个月）。16 例患儿中有 3 例（3/16）在长春新碱维持治疗期间进展，4 例（4/16）在维持治疗结束后进展。在总治疗期间，4 例患者出现临床改善，9 例患者症状稳定，仅 3 例患者进展。1 年和 2 年无事件生存率分别为 81.2%和 56.2%。2 年总生存率为 93.7%。
我们在此报告，在儿童低级别胶质瘤中，在初始 B 或 BI 诱导后添加每周长春新碱维持治疗可带来潜在益处和无进展生存期的改善。
