Difference between revisions of "Neuroblastoma"
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Revision as of 16:45, 22 March 2018
Section editor | |
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Wayne H. Liang, MD, MS Birmingham, AL Twitter: WayneLiangMD |
Neuroblastoma is a rare cancer but is the most common malignancy of infancy.
14 regimens on this page
15 variants on this page
|
Low-risk
Intermediate-risk
High-risk, consolidation
Dinutuximab, GM-CSF, IL-2, Isotretinoin
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Yu et al. 2010 (COG ANBL0032) | Phase III | Isotretinoin | Seems to have superior OS |
Note: in distinction from most chemotherapy regimens, the first day of a cycle is day 0 and the last day of a 28-day cycle is day 27.
Immunotherapy
- Dinutuximab (Unituxin) as follows:
- Cycles 1, 3, 5: 25 mg/m2 IV once per day on days 3 to 6
- Cycles 2 & 4: 25 mg/m2 IV once per day on days 7 to 10
- Sargramostim (Leukine) as follows:
- Cycles 1, 3, 5: 250 mcg/m2 SC once per day on days 0 to 13
- Aldesleukin (Proleukin) as follows:
- Cycles 2 & 4: 3.0 x 106 IU/m2/day IV continuous infusion on days 0 to 3, then 4.5 x 106 IU/m2/day IV continuous infusion on days 7 to 10
- Isotretinoin (Accutane) 160 mg/m2/day PO on days 14 to 27
28-day cycle for 6 cycles
References
- Yu AL, Gilman AL, Ozkaynak MF, London WB, Kreissman SG, Chen HX, Smith M, Anderson B, Villablanca JG, Matthay KK, Shimada H, Grupp SA, Seeger R, Reynolds CP, Buxton A, Reisfeld RA, Gillies SD, Cohn SL, Maris JM, Sondel PM; Children's Oncology Group. Anti-GD2 antibody with GM-CSF, interleukin-2, and isotretinoin for neuroblastoma. N Engl J Med. 2010 Sep 30;363(14):1324-34. link to original article link to PMC article contains verified protocol PubMed
Isotretinoin monotherapy
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Yu et al. 2010 (COG ANBL0032) | Phase III | Dinutuximab, GM-CSF, IL-2, Isotretinoin | Seems to have inferior OS |
Chemotherapy
- Isotretinoin (Accutane) 80 mg/m2 BID on days 1 to 14
28-day cycle for 6 cycles
References
- Yu AL, Gilman AL, Ozkaynak MF, London WB, Kreissman SG, Chen HX, Smith M, Anderson B, Villablanca JG, Matthay KK, Shimada H, Grupp SA, Seeger R, Reynolds CP, Buxton A, Reisfeld RA, Gillies SD, Cohn SL, Maris JM, Sondel PM; Children's Oncology Group. Anti-GD2 antibody with GM-CSF, interleukin-2, and isotretinoin for neuroblastoma. N Engl J Med. 2010 Sep 30;363(14):1324-34. link to original article link to PMC article contains verified protocol PubMed
Relapsed or refractory
Irinotecan, Temozolomide, Dinutuximab
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Mody et al. 2017 (COG ANBL1221) | Randomized phase II, <20 pts | Irinotecan, Temozolomide, Temsirolimus | Superior ORR |
Note: this dinutuximab dose is based on a mid-protocol revision.
Chemoimmunotherapy
- Irinotecan (Camptosar) 50 mg/m2 IV over 90 minutes once per day on days 1 to 5
- Temozolomide (Temodar) 100 mg/m2 PO once per day on days 1 to 5
- Dinutuximab (Unituxin) 17.5 mg/m2 IV over 10 hours once per day on days 2 to 5
- Infusion time could be extended to 20 hours "if patients experienced pain, fever, tachycardia, tachypnea, or hypotension unresponsive to supportive measures."
Supportive medications
- Sargramostim (Leukine) 250 mcg/m2 SC once per day on days 6 to 12
21-day cycle for up to 17 cycles
References
- Mody R, Naranjo A, Van Ryn C, Yu AL, London WB, Shulkin BL, Parisi MT, Servaes SE, Diccianni MB, Sondel PM, Bender JG, Maris JM, Park JR, Bagatell R. Irinotecan-temozolomide with temsirolimus or dinutuximab in children with refractory or relapsed neuroblastoma (COG ANBL1221): an open-label, randomised, phase 2 trial. Lancet Oncol. 2017 Jul;18(7):946-957. Epub 2017 May 23. link to original article link to PMC article contains verified protocol PubMed