Difference between revisions of "Pheochromocytoma"
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=Guidelines= | =Guidelines= | ||
==ESMO-EURACAN== | ==ESMO-EURACAN== | ||
*'''2020:''' Fassnacht et al. [https://doi.org/10.1016/j.annonc.2020.08.2099 Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up] | *'''2020:''' Fassnacht et al. [https://doi.org/10.1016/j.annonc.2020.08.2099 Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up] | ||
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==NANETS== | ==NANETS== | ||
*'''2021:''' Fishbein et al. [https://doi.org/10.1097/mpa.0000000000001792 The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma] | *'''2021:''' Fishbein et al. [https://doi.org/10.1097/mpa.0000000000001792 The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma] | ||
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==[https://www.nccn.org/ NCCN]== | ==[https://www.nccn.org/ NCCN]== | ||
*[https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf NCCN Guidelines - Neuroendocrine Tumors] | *[https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf NCCN Guidelines - Neuroendocrine Tumors] | ||
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=All lines of therapy= | =All lines of therapy= | ||
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==Cyclophosphamide, Dacarbazine, Vincristine {{#subobject:6ff914|Regimen=1}}== | ==Cyclophosphamide, Dacarbazine, Vincristine {{#subobject:6ff914|Regimen=1}}== | ||
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CVD: '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>D</u>'''acarbazine | CVD: '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>D</u>'''acarbazine | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:5998d1|Variant=1}}=== | ===Regimen {{#subobject:5998d1|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
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====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1 | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1 | ||
*[[Dacarbazine (DTIC)]] 600 mg/m<sup>2</sup> IV once per day on days 1 & 2 | *[[Dacarbazine (DTIC)]] 600 mg/m<sup>2</sup> IV once per day on days 1 & 2 | ||
*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> IV once on day 1 | *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> IV once on day 1 | ||
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'''21-day cycles''' | '''21-day cycles''' | ||
| − | + | </div></div> | |
===References=== | ===References=== | ||
# 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. [https://doi.org/10.7326/0003-4819-109-4-267 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/3395037 PubMed] | # 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. [https://doi.org/10.7326/0003-4819-109-4-267 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/3395037 PubMed] | ||
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==<sup>131</sup>I-Metaiodobenzylguanidine (<sup>131</sup>I-MIBG) {{#subobject:57992a|Regimen=1}}== | ==<sup>131</sup>I-Metaiodobenzylguanidine (<sup>131</sup>I-MIBG) {{#subobject:57992a|Regimen=1}}== | ||
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Also known as m-[131I]iodobenzylguanidine ([131I]MIBG). | Also known as m-[131I]iodobenzylguanidine ([131I]MIBG). | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen variant #1 {{#subobject:f474b2|Variant=1}}=== | ===Regimen variant #1 {{#subobject:f474b2|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
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| − | ''Patients underwent stem cell harvest prior to treatment in case autologous stem cell infusion was needed.'' | + | ''Note: Patients underwent stem cell harvest prior to treatment in case autologous stem cell infusion was needed.'' |
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
*<sup>131</sup>I-Metaiodobenzylguanidine (<sup>131</sup>I-MIBG) 12 to 18 mCi/kg (maximum single dose of 850 mCi) IV over 2 hours once on day 1 | *<sup>131</sup>I-Metaiodobenzylguanidine (<sup>131</sup>I-MIBG) 12 to 18 mCi/kg (maximum single dose of 850 mCi) IV over 2 hours once on day 1 | ||
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====Supportive therapy==== | ====Supportive therapy==== | ||
*Intravenous fluids started 12 hours before 131I-MIBG administration. | *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 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 every 6 hours x 5 days. | *Potassium perchlorate 8 mg/kg once at least 2 hours prior to 131I-MIBG, then potassium perchlorate 2 mg/kg PO every 6 hours x 5 days. | ||
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'''"Repeat 131I-MIBG treatments were administered on a case-by-case basis in an effort to improve the overall response"''' | '''"Repeat 131I-MIBG treatments were administered on a case-by-case basis in an effort to improve the overall response"''' | ||
| − | + | </div></div><br> | |
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===Regimen variant #2 {{#subobject:53e027|Variant=1}}=== | ===Regimen variant #2 {{#subobject:53e027|Variant=1}}=== | ||
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====Radiotherapy==== | ====Radiotherapy==== | ||
*m-[131I]iodobenzylguanidine ([131I]MIBG) 740 megabequerel/mg every 3 months | *m-[131I]iodobenzylguanidine ([131I]MIBG) 740 megabequerel/mg every 3 months | ||
| − | + | </div></div> | |
===References=== | ===References=== | ||
# 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. [https://doi.org/10.1210/jcem-72-2-455 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/1991814 PubMed] | # 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. [https://doi.org/10.1210/jcem-72-2-455 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/1991814 PubMed] | ||
# 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. [https://doi.org/10.1002/cncr.11518 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/12872341 PubMed] | # 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. [https://doi.org/10.1002/cncr.11518 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/12872341 PubMed] | ||
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[[Category:Pheochromocytoma regimens]] | [[Category:Pheochromocytoma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Endocrine cancers]] | [[Category:Endocrine cancers]] | ||
Revision as of 17:27, 28 February 2023
3 regimens on this page
5 variants on this page
|
Guidelines
ESMO-EURACAN
- 2020: Fassnacht et al. Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up
NANETS
- 2021: Fishbein et al. The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma
NCCN
All lines of therapy
Cyclophosphamide, Dacarbazine, Vincristine
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
- 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 dosing details in abstract PubMed
131I-Metaiodobenzylguanidine (131I-MIBG)
Also known as m-[131I]iodobenzylguanidine ([131I]MIBG).
Regimen variant #1
| Study | Evidence |
|---|---|
| Rose et al. 2003b | Pilot, <20 pts |
Note: 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 therapy
- 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 every 6 hours x 5 days.
"Repeat 131I-MIBG treatments were administered on a case-by-case basis in an effort to improve the overall response"
Regimen variant #2
| Study | Evidence |
|---|---|
| Krempf et al. 1991 | Pilot, <20 pts |
Radiotherapy
- m-[131I]iodobenzylguanidine ([131I]MIBG) 740 megabequerel/mg every 3 months
References
- 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 dosing details in abstract PubMed
- 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 dosing details in manuscript PubMed