Campbell L A, Seeger R C, Harris R E, Villablanca J G, Matthay K K
Department of Pediatrics, University of California, San Francisco.
J Clin Oncol. 1993 Apr;11(4):623-9. doi: 10.1200/JCO.1993.11.4.623.
This trial was undertaken to determine if a continuous infusion format with increased dose-intensity had antitumor activity with tolerable toxicity in patients with advanced neuroblastoma.
Forty heavily pretreated patients with refractory or progressive neuroblastoma received continuous infusion doxorubicin, cisplatin, and etoposide along with bolus ifosfamide in a dose-escalation format. A total of 79 courses of chemotherapy were administered at five different dose levels.
Fifteen of 35 assessable patients (43%) achieved either a partial response (PR) or complete response (CR), including five patients with a CR, three with a very good PR (VGPR), and seven with a PR. Hematologic toxicity was severe, but reversible, and other toxicities, although significant, were tolerable and much less than that accepted in a bone marrow transplantation (BMT) setting.
This investigation illustrates that response is possible even in an extremely poor-prognosis group of patients, and it suggests that such a regimen may be effective if given before disease progression occurs.
本试验旨在确定增加剂量强度的持续输注方案对晚期神经母细胞瘤患者是否具有抗肿瘤活性且毒性可耐受。
40例经过多次治疗的难治性或进展性神经母细胞瘤患者接受持续输注多柔比星、顺铂和依托泊苷，并按剂量递增方案给予大剂量异环磷酰胺推注。共在五个不同剂量水平给予79个疗程的化疗。
35例可评估患者中有15例（43%）达到部分缓解（PR）或完全缓解（CR），包括5例CR患者、3例非常好的部分缓解（VGPR）患者和7例PR患者。血液学毒性严重，但可逆，其他毒性虽然显著，但可耐受，且远低于骨髓移植（BMT）情况下的毒性。
本研究表明，即使在预后极差的患者群体中也可能出现缓解，并且提示在疾病进展前给予这样的方案可能有效。
