Difference between revisions of "Wilms tumor"

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[[#top|Back to Top]]
 
[[#top|Back to Top]]
 
</div>
 
</div>
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{{#lst:Section editor transclusions|blastomas}}
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{{#lst:Editorial board transclusions|blastomas}}
 
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{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
 
=Guidelines=
 
=Guidelines=
 +
'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
 
==[https://www.nccn.org NCCN]==
 
==[https://www.nccn.org NCCN]==
−
*[https://www.nccn.org/professionals/physician_gls/pdf/wilms_tumor.pdf NCCN Guidelines - Wilms Tumor (Nephroblastoma)]
+
*[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1500 NCCN Guidelines - Wilms Tumor (Nephroblastoma)]
−
=All lines of therapy=
+
 
 +
=Neoadjuvant therapy=
 +
==Vincristine monotherapy {{#subobject:ec500f|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen {{#subobject:a67321|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 60%; text-align:center;"
 +
!style="width: 33%"|Study
 +
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1001/jama.1967.03130180047006 Sullivan et al. 1967]
 +
|1965-1966
 +
| style="background-color:#ffffbe" |Pilot
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Chemotherapy====
 +
*[[Vincristine (Oncovin)]]
 +
</div>
 +
<div class="toccolours" style="background-color:#cbd5e7">
 +
====Subsequent treatment====
 +
*[[Surgery#Surgical_resection|Surgical resection]]
 +
</div></div>
 +
===References===
 +
# Sullivan MP, Sutow WW, Cangir A, Taylor G. Vincristine sulfate in management of Wilms' tumor: replacement of preoperative irradiation by chemotherapy. JAMA. 1967 Oct 30;202(5):381-4. [https://doi.org/10.1001/jama.1967.03130180047006 link to original article] [https://pubmed.ncbi.nlm.nih.gov/4293363/ PubMed]
 +
# '''NWTS-1:''' D'Angio GJ, Evans AE, Breslow N, Beckwith B, Bishop H, Feigl P, Goodwin W, Leape LL, Sinks LF, Sutow W, Tefft M, Wolff J. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer. 1976 Aug;38(2):633-46. [https://doi.org/10.1002/1097-0142(197608)38:2%3C633::AID-CNCR2820380203%3E3.0.CO;2-S link to original article] [https://pubmed.ncbi.nlm.nih.gov/184912/ PubMed]
 +
 
 +
=Adjuvant therapy=
 
==Dactinomycin monotherapy {{#subobject:ea894c|Regimen=1}}==
 
==Dactinomycin monotherapy {{#subobject:ea894c|Regimen=1}}==
 
<div class="toccolours" style="background-color:#eeeeee">
 
<div class="toccolours" style="background-color:#eeeeee">
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|-
 
|-
 
|[https://doi.org/10.1056/NEJM196808082790605 Wolff et al. 1968]
 
|[https://doi.org/10.1056/NEJM196808082790605 Wolff et al. 1968]
−
|1964-NR
+
|1964 to not reported
 
| style="background-color:#1a9851" |Randomized (E-esc)
 
| style="background-color:#1a9851" |Randomized (E-esc)
 
|[[#Dactinomycin_monotherapy|Dactinomycin]] x 1
 
|[[#Dactinomycin_monotherapy|Dactinomycin]] x 1
 
| style="background-color:#91cf60" |Seems to have superior RFS
 
| style="background-color:#91cf60" |Seems to have superior RFS
 +
|-
 +
|rowspan=2|[https://doi.org/10.1002/1097-0142(197608)38:2%3C633::AID-CNCR2820380203%3E3.0.CO;2-S D'Angio et al. 1976 (NWTS-1)]
 +
|rowspan=2|1969-1973
 +
|rowspan=2 style="background-color:#1a9851" |Randomized (C)
 +
|1. [[#Dactinomycin_.26_Vincristine|Dactinomycin & Vincristine]]
 +
| style="background-color:#d73027" |Inferior RFS
 +
|-
 +
|2. [[#Vincristine_monotherapy|Vincristine]]
 +
|style="background-color:#d3d3d3" |Not reported
 
|-
 
|-
 
|}
 
|}
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===References===
 
===References===
 
# Wolff JA, Newton WA Jr, Krivit W, D'Angio GJ. Single versus multiple dose dactinomycin therapy of Wilms's tumor: a controlled co-operative study conducted by the Children's Cancer Study Group A (formerly Acute Leukemia Co-operative Chemotherapy Group A). N Engl J Med. 1968 Aug 8;279(6):290-4. [https://doi.org/10.1056/NEJM196808082790605 link to original article] [https://pubmed.ncbi.nlm.nih.gov/4298260/ PubMed]
 
# Wolff JA, Newton WA Jr, Krivit W, D'Angio GJ. Single versus multiple dose dactinomycin therapy of Wilms's tumor: a controlled co-operative study conducted by the Children's Cancer Study Group A (formerly Acute Leukemia Co-operative Chemotherapy Group A). N Engl J Med. 1968 Aug 8;279(6):290-4. [https://doi.org/10.1056/NEJM196808082790605 link to original article] [https://pubmed.ncbi.nlm.nih.gov/4298260/ PubMed]
−
## '''Update:''' Wolff JA, D'Angio G, Hartmann J, Krivit W, Newton WA Jr. Long-term evaluation of single versus multiple courses of actinomycin D therapy of Wilms's tumor. N Engl J Med. 1974 Jan 10;290(2):84-6. [https://doi.org/10.1056/NEJM197401102900205 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/4357042/ PubMed]
+
## '''Update:''' Wolff JA, D'Angio G, Hartmann J, Krivit W, Newton WA Jr. Long-term evaluation of single versus multiple courses of actinomycin D therapy of Wilms's tumor. N Engl J Med. 1974 Jan 10;290(2):84-6. [https://doi.org/10.1056/NEJM197401102900205 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/4357042/ PubMed]
 +
# '''NWTS-1:''' D'Angio GJ, Evans AE, Breslow N, Beckwith B, Bishop H, Feigl P, Goodwin W, Leape LL, Sinks LF, Sutow W, Tefft M, Wolff J. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer. 1976 Aug;38(2):633-46. [https://doi.org/10.1002/1097-0142(197608)38:2%3C633::AID-CNCR2820380203%3E3.0.CO;2-S link to original article] [https://pubmed.ncbi.nlm.nih.gov/184912/ PubMed]
 
==Dactinomycin & Vincristine {{#subobject:3f9a1a|Regimen=1}}==
 
==Dactinomycin & Vincristine {{#subobject:3f9a1a|Regimen=1}}==
 
<div class="toccolours" style="background-color:#eeeeee">
 
<div class="toccolours" style="background-color:#eeeeee">
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|1969-1973
 
|1969-1973
 
| style="background-color:#1a9851" |Randomized (E-RT-esc)
 
| style="background-color:#1a9851" |Randomized (E-RT-esc)
−
|1. [[#Dactinomycin_monotherapy|Dactinomycin]]<br>2. [[#Vincristine_monotherapy_88|Vincristine]]
+
|1. [[#Dactinomycin_monotherapy|Dactinomycin]]<br>2. [[#Vincristine_monotherapy|Vincristine]]
 
| style="background-color:#1a9850" |Superior RFS
 
| style="background-color:#1a9850" |Superior RFS
 
|-
 
|-
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|2001-2009
 
|2001-2009
 
| style="background-color:#1a9851" |Phase 3 (E-de-esc)
 
| style="background-color:#1a9851" |Phase 3 (E-de-esc)
−
|[[#Dactinomycin.2C_Doxorubicin.2C_Vincristine_88|Dactinomycin, Doxorubicin, Vincristine]]
+
|[[#Dactinomycin.2C_Doxorubicin.2C_Vincristine_888|Dactinomycin, Doxorubicin, Vincristine]]
−
| style="background-color:#eeee01" |Non-inferior EFS
+
| style="background-color:#eeee01" |Non-inferior EFS24 (primary endpoint)
 
|-
 
|-
 
|}
 
|}
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<div class="toccolours" style="background-color:#b3e2cd">
 
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Dactinomycin (Cosmegen)]]
+
*[[Dactinomycin (Cosmegen)]] 45 mcg/kg (maximum dose of 2 mg) IV bolus once on day 8
−
*[[Vincristine (Oncovin)]]
+
*[[Vincristine (Oncovin)]] as follows:
 +
**Cycles 1 & 2: 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV bolus once per day on days 1, 8, 15
 +
**Cycle 3: 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV bolus once per day on days 1 & 8
 +
**Cycles 4 to 9: 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV bolus once per day on days 8 & 15
 +
'''21-day cycle for 9 cycles'''
 
</div></div>
 
</div></div>
 
===References===
 
===References===
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# '''NWTS-3:''' D'Angio GJ, Breslow N, Beckwith JB, Evans A, Baum H, deLorimier A, Fernbach D, Hrabovsky E, Jones B, Kelalis P, Othersen B, Tefft M, Thomas PRM. Treatment of Wilms' tumor: results of the Third National Wilms' Tumor Study. Cancer. 1989 Jul 15;64(2):349-60. [https://doi.org/10.1002/1097-0142(19890715)64:2%3C349::AID-CNCR2820640202%3E3.0.CO;2-Q link to original article] [https://pubmed.ncbi.nlm.nih.gov/2544249/ PubMed]
 
# '''NWTS-3:''' D'Angio GJ, Breslow N, Beckwith JB, Evans A, Baum H, deLorimier A, Fernbach D, Hrabovsky E, Jones B, Kelalis P, Othersen B, Tefft M, Thomas PRM. Treatment of Wilms' tumor: results of the Third National Wilms' Tumor Study. Cancer. 1989 Jul 15;64(2):349-60. [https://doi.org/10.1002/1097-0142(19890715)64:2%3C349::AID-CNCR2820640202%3E3.0.CO;2-Q link to original article] [https://pubmed.ncbi.nlm.nih.gov/2544249/ PubMed]
 
# '''NWTS-4:''' Ritchey ML, Shamberger RC, Haase G, Horwitz J, Bergemann T, Breslow NE. Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group. J Am Coll Surg. 2001 Jan;192(1):63-8. [https://doi.org/10.1016/s1072-7515(00)00749-3 link to original article] [https://pubmed.ncbi.nlm.nih.gov/11192924/ PubMed]
 
# '''NWTS-4:''' Ritchey ML, Shamberger RC, Haase G, Horwitz J, Bergemann T, Breslow NE. Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group. J Am Coll Surg. 2001 Jan;192(1):63-8. [https://doi.org/10.1016/s1072-7515(00)00749-3 link to original article] [https://pubmed.ncbi.nlm.nih.gov/11192924/ PubMed]
−
# '''SIOP 93-01:''' de Kraker J, Graf N, van Tinteren H, Pein F, Sandstedt B, Godzinski J, Tournade MF; SIOP. Reduction of postoperative chemotherapy in children with stage I intermediate-risk and anaplastic Wilms' tumour (SIOP 93-01 trial): a randomised controlled trial. Lancet. 2004 Oct 2-8;364(9441):1229-35. [https://doi.org/10.1016/S0140-6736(04)17139-0 link to original article] [https://pubmed.ncbi.nlm.nih.gov/15464183/ PubMed] NCT00003804
+
# '''SIOP 93-01:''' de Kraker J, Graf N, van Tinteren H, Pein F, Sandstedt B, Godzinski J, Tournade MF; SIOP. Reduction of postoperative chemotherapy in children with stage I intermediate-risk and anaplastic Wilms' tumour (SIOP 93-01 trial): a randomised controlled trial. Lancet. 2004 Oct 2-8;364(9441):1229-35. [https://doi.org/10.1016/S0140-6736(04)17139-0 link to original article] [https://pubmed.ncbi.nlm.nih.gov/15464183/ PubMed] [https://clinicaltrials.gov/study/NCT00003804 NCT00003804]
−
# '''SIOP WT 2001:''' Pritchard-Jones K, Bergeron C, de Camargo B, van den Heuvel-Eibrink MM, Acha T, Godzinski J, Oldenburger F, Boccon-Gibod L, Leuschner I, Vujanic G, Sandstedt B, de Kraker J, van Tinteren H, Graf N; SIOP Renal Tumours Study Group. Omission of doxorubicin from the treatment of stage II-III, intermediate-risk Wilms' tumour (SIOP WT 2001): an open-label, non-inferiority, randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1156-64. Epub 2015 Jul 9. [https://doi.org/10.1016/S0140-6736(14)62395-3 link to original article] [https://pubmed.ncbi.nlm.nih.gov/26164096/ PubMed] NCT00047138
+
# '''SIOP WT 2001:''' Pritchard-Jones K, Bergeron C, de Camargo B, van den Heuvel-Eibrink MM, Acha T, Godzinski J, Oldenburger F, Boccon-Gibod L, Leuschner I, Vujanic G, Sandstedt B, de Kraker J, van Tinteren H, Graf N; SIOP Renal Tumours Study Group. Omission of doxorubicin from the treatment of stage II-III, intermediate-risk Wilms' tumour (SIOP WT 2001): an open-label, non-inferiority, randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1156-64. Epub 2015 Jul 9. [https://doi.org/10.1016/S0140-6736(14)62395-3 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/26164096/ PubMed] [https://clinicaltrials.gov/study/NCT00047138 NCT00047138]
−
==Vincristine monotherapy {{#subobject:ec500f|Regimen=1}}==
+
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Regimen {{#subobject:a67321|Variant=1}}===
 
−
{| class="wikitable" style="width: 40%; text-align:center;"
 
−
!style="width: 25%"|Study
 
−
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
−
|-
 
−
|[https://jamanetwork.com/journals/jama/article-abstract/335953 Sullivan et al. 1967]
 
−
| style="background-color:#ffffbe" |Pilot
 
−
|-
 
−
|}
 
−
<div class="toccolours" style="background-color:#b3e2cd">
 
−
====Chemotherapy====
 
−
*[[Vincristine (Oncovin)]]
 
−
</div>
 
−
<div class="toccolours" style="background-color:#cbd5e7">
 
−
====Subsequent treatment====
 
−
*[[Surgery#Surgical_resection|Surgical resection]]
 
−
</div></div>
 
−
===References===
 
−
# Sullivan MP, Sutow WW, Cangir A, Taylor G. Vincristine sulfate in management of Wilms' tumor: replacement of preoperative irradiation by chemotherapy. JAMA. 1967 Oct 30;202(5):381-4. [https://jamanetwork.com/journals/jama/article-abstract/335953 link to original article] [https://pubmed.ncbi.nlm.nih.gov/4293363/ PubMed]
 
 
[[Category:Wilms tumor regimens]]
 
[[Category:Wilms tumor regimens]]
 
[[Category:Disease-specific pages]]
 
[[Category:Disease-specific pages]]
 
[[Category:Pediatric solid tumors]]
 
[[Category:Pediatric solid tumors]]

Latest revision as of 20:32, 15 July 2024

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Section editor
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 Elaine Fan, MD
KU School of Medicine
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Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

NCCN

Neoadjuvant therapy

Vincristine monotherapy

Regimen

Study Dates of enrollment Evidence
Sullivan et al. 1967 1965-1966 Pilot

Chemotherapy

Subsequent treatment

References

  1. Sullivan MP, Sutow WW, Cangir A, Taylor G. Vincristine sulfate in management of Wilms' tumor: replacement of preoperative irradiation by chemotherapy. JAMA. 1967 Oct 30;202(5):381-4. link to original article PubMed
  2. NWTS-1: D'Angio GJ, Evans AE, Breslow N, Beckwith B, Bishop H, Feigl P, Goodwin W, Leape LL, Sinks LF, Sutow W, Tefft M, Wolff J. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer. 1976 Aug;38(2):633-46. link to original article PubMed

Adjuvant therapy

Dactinomycin monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Wolff et al. 1968 1964 to not reported Randomized (E-esc) Dactinomycin x 1 Seems to have superior RFS
D'Angio et al. 1976 (NWTS-1) 1969-1973 Randomized (C) 1. Dactinomycin & Vincristine Inferior RFS
2. Vincristine Not reported

Preceding treatment

Chemotherapy

6-week cycle for 3 cycles, then 3-month cycle for 4 cycles

References

  1. Wolff JA, Newton WA Jr, Krivit W, D'Angio GJ. Single versus multiple dose dactinomycin therapy of Wilms's tumor: a controlled co-operative study conducted by the Children's Cancer Study Group A (formerly Acute Leukemia Co-operative Chemotherapy Group A). N Engl J Med. 1968 Aug 8;279(6):290-4. link to original article PubMed
    1. Update: Wolff JA, D'Angio G, Hartmann J, Krivit W, Newton WA Jr. Long-term evaluation of single versus multiple courses of actinomycin D therapy of Wilms's tumor. N Engl J Med. 1974 Jan 10;290(2):84-6. link to original article dosing details in manuscript have been reviewed by our editors PubMed
  2. NWTS-1: D'Angio GJ, Evans AE, Breslow N, Beckwith B, Bishop H, Feigl P, Goodwin W, Leape LL, Sinks LF, Sutow W, Tefft M, Wolff J. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer. 1976 Aug;38(2):633-46. link to original article PubMed

Dactinomycin & Vincristine

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
D'Angio et al. 1976 (NWTS-1) 1969-1973 Randomized (E-RT-esc) 1. Dactinomycin
2. Vincristine 		Superior RFS
D'Angio et al. 1981 (NWTS-2) 1974-1978 Randomized (E-RT-de-esc) Dactinomycin & Vincristine; longer duration Did not meet primary endpoint of RFS
D'Angio et al. 1989 (NWTS-3) 1979-1985 Randomized (E-RT-de-esc) Dactinomycin & Vincristine; longer duration Did not meet primary endpoint of RFS
Ritchey et al. 2001 (NWTS-4) 1986-1994 Non-randomized (RT)
de Kraker et al. 2004 (SIOP 93-01) 1993-2000 Phase 3 (E-de-esc) Prolonged chemotherapy Equivalent EFS
Pritchard-Jones et al. 2015 (SIOP WT 2001) 2001-2009 Phase 3 (E-de-esc) Dactinomycin, Doxorubicin, Vincristine Non-inferior EFS24 (primary endpoint)

Note: Ritchey et al. 2001 does not appear to be a primary publication of the NWTS-4 results, but no other publications could be found; details including phase of study are unclear.

Preceding treatment

Chemotherapy

  • Dactinomycin (Cosmegen) 45 mcg/kg (maximum dose of 2 mg) IV bolus once on day 8
  • Vincristine (Oncovin) as follows:
    • Cycles 1 & 2: 1.5 mg/m2 (maximum dose of 2 mg) IV bolus once per day on days 1, 8, 15
    • Cycle 3: 1.5 mg/m2 (maximum dose of 2 mg) IV bolus once per day on days 1 & 8
    • Cycles 4 to 9: 1.5 mg/m2 (maximum dose of 2 mg) IV bolus once per day on days 8 & 15

21-day cycle for 9 cycles

References

  1. NWTS-1: D'Angio GJ, Evans AE, Breslow N, Beckwith B, Bishop H, Feigl P, Goodwin W, Leape LL, Sinks LF, Sutow W, Tefft M, Wolff J. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer. 1976 Aug;38(2):633-46. link to original article PubMed
  2. NWTS-2: D'Angio GJ, Evans A, Breslow N, Beckwith B, Bishop H, Farewell V, Goodwin W, Leape L, Palmer N, Sinks L, Sutow W, Tefft M, Wolff J. The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study. Cancer. 1981 May 1;47(9):2302-11. link to original article PubMed
  3. NWTS-3: D'Angio GJ, Breslow N, Beckwith JB, Evans A, Baum H, deLorimier A, Fernbach D, Hrabovsky E, Jones B, Kelalis P, Othersen B, Tefft M, Thomas PRM. Treatment of Wilms' tumor: results of the Third National Wilms' Tumor Study. Cancer. 1989 Jul 15;64(2):349-60. link to original article PubMed
  4. NWTS-4: Ritchey ML, Shamberger RC, Haase G, Horwitz J, Bergemann T, Breslow NE. Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group. J Am Coll Surg. 2001 Jan;192(1):63-8. link to original article PubMed
  5. SIOP 93-01: de Kraker J, Graf N, van Tinteren H, Pein F, Sandstedt B, Godzinski J, Tournade MF; SIOP. Reduction of postoperative chemotherapy in children with stage I intermediate-risk and anaplastic Wilms' tumour (SIOP 93-01 trial): a randomised controlled trial. Lancet. 2004 Oct 2-8;364(9441):1229-35. link to original article PubMed NCT00003804
  6. SIOP WT 2001: Pritchard-Jones K, Bergeron C, de Camargo B, van den Heuvel-Eibrink MM, Acha T, Godzinski J, Oldenburger F, Boccon-Gibod L, Leuschner I, Vujanic G, Sandstedt B, de Kraker J, van Tinteren H, Graf N; SIOP Renal Tumours Study Group. Omission of doxorubicin from the treatment of stage II-III, intermediate-risk Wilms' tumour (SIOP WT 2001): an open-label, non-inferiority, randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1156-64. Epub 2015 Jul 9. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00047138
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