Neuroblastoma
Revision as of 14:14, 21 July 2018 by Jwarner (talk | contribs) (→Isotretinoin monotherapy {{#subobject:d9be60|Regimen=1}})
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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
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Low-risk
Intermediate-risk
COG A3961
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Regimen
| Study | Evidence |
|---|---|
| Baker et al. 2010 (COG A3961) | Non-randomized |
To be completed.
Chemotherapy
- See paper for details
References
- COG A3961: Baker DL, Schmidt ML, Cohn SL, Maris JM, London WB, Buxton A, Stram D, Castleberry RP, Shimada H, Sandler A, Shamberger RC, Look AT, Reynolds CP, Seeger RC, Matthay KK; Children’s Oncology Group. Outcome after reduced chemotherapy for intermediate-risk neuroblastoma. N Engl J Med. 2010 Sep 30;363(14):1313-23. link to original article link to PMC article PubMed
High-risk, consolidation
Dinutuximab, GM-CSF, IL-2, Isotretinoin
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Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Yu et al. 2010 (COG ANBL0032) | Phase III (E) | 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
- COG ANBL0032: 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
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Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Matthay et al. 1999 | Phase III (E) | No further therapy | Seems to have superior EFS |
| Yu et al. 2010 (COG ANBL0032) | Phase III (C) | Dinutuximab, GM-CSF, IL-2, Isotretinoin | Seems to have inferior OS |
Preceding treatment
- Matthay et al. 1999: HDT with purged auto HSCT versus cisplatin, doxorubicin, etoposide consolidation
Chemotherapy
- Isotretinoin (Accutane) 80 mg/m2 BID on days 1 to 14
28-day cycle for 6 cycles
References
- Matthay KK, Villablanca JG, Seeger RC, Stram DO, Harris RE, Ramsay NK, Swift P, Shimada H, Black CT, Brodeur GM, Gerbing RB, Reynolds CP. Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis-retinoic acid. Children's Cancer Group. N Engl J Med. 1999 Oct 14;341(16):1165-73. link to original article contains verified protocol PubMed
- COG ANBL0032: 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