Pheochromocytoma

Section editor
	Jeena M. Varghese, MBBS MD Anderson Cancer Center Houston, TX LinkedIn

3 regimens on this page 5 variants on this page

Guidelines

NCCN

• NCCN Guidelines - Neuroendocrine Tumors

All lines of therapy

Cyclophosphamide, Dacarbazine, Vincristine

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CVD: Cyclophosphamide, Vincristine, Dacarbazine

Regimen

Study	Evidence
Averbuch et al. 1988	Pilot, <20 pts

Chemotherapy

• Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
• Dacarbazine (DTIC) 600 mg/m² IV once per day on days 1 & 2
• Vincristine (Oncovin) 1.4 mg/m² IV once on day 1

21-day cycles

References

1. Averbuch SD, Steakley CS, Young RC, Gelmann EP, Goldstein DS, Stull R, Keiser HR. Malignant pheochromocytoma: effective treatment with a combination of cyclophosphamide, vincristine, and dacarbazine. Ann Intern Med. 1988 Aug 15;109(4):267-73. link to original article contains protocol PubMed

¹³¹I-Metaiodobenzylguanidine (¹³¹I-MIBG)

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Also known as m-[131I]iodobenzylguanidine ([131I]MIBG).

Variant #1

Study	Evidence
Rose et al. 2003	Pilot, <20 pts

Patients underwent stem cell harvest prior to treatment in case autologous stem cell infusion was needed.

Radiotherapy

• ¹³¹I-Metaiodobenzylguanidine (¹³¹I-MIBG) 12 to 18 mCi/kg (maximum single dose of 850 mCi) IV over 2 hours once on day 1

Supportive medications

• Intravenous fluids started 12 hours before 131I-MIBG administration.
• Potassium iodide (KI) 6 mg/kg PO once at least 2 hours prior to 131I-MIBG, then potassium iodide (KI) 0.88 mg/kg PO Q4H x 7 days, then potassium iodide (KI) 1 mg/kg PO (frequency not specified) "for 45 days after the infusion."
• Potassium perchlorate 8 mg/kg once at least 2 hours prior to 131I-MIBG, then potassium perchlorate 2 mg/kg PO Q6H x 5 days.

"Repeat 131I-MIBG treatments were administered on a case-by-case basis in an effort to improve the overall response"

Variant #2

Study	Evidence
Krempf et al. 1991	Pilot, <20 pts

Radiotherapy

• m-[131I]iodobenzylguanidine ([131I]MIBG) 740 megabequerel/mg every 3 months

References

1. Krempf M, Lumbroso J, Mornex R, Brendel AJ, Wemeau JL, Delisle MJ, Aubert B, Carpentier P, Fleury-Goyon MC, Gibold C, Guyot M, Lahneche B, Marchandise X, Schlumberger M, Charbonnel B, Chatal JF. Use of m-[131I]iodobenzylguanidine in the treatment of malignant pheochromocytoma. J Clin Endocrinol Metab. 1991 Feb;72(2):455-61. link to original article contains protocol PubMed
2. Rose B, Matthay KK, Price D, Huberty J, Klencke B, Norton JA, Fitzgerald PA. High-dose 131I-metaiodobenzylguanidine therapy for 12 patients with malignant pheochromocytoma. Cancer. 2003 Jul 15;98(2):239-48. link to original article contains verified protocol PubMed