Low-grade glioma, pediatric

Section editor
	Nikki M. Wood, DO University of Missouri Kansas City, MO LinkedIn

This page contains studies that are specific to pediatric populations. For the more general low-grade glioma category page, follow this link.

3 regimens on this page 5 variants on this page

Adjuvant therapy

Carboplatin & Vincristine

CV: Carboplatin & Vincristine
VC: Vincristine & Carboplatin

Regimen variant #1, 175/1.5 (capped vincristine)

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Packer et al. 1993	NR	Non-randomized
Ater et al. 2012 (COG A9952)	1997-2005	Phase 3 (C)	TPCV	Did not meet primary endpoints of EFS/OS

Note: The course begins on day 0.

Preceding treatment

• Biopsy or incomplete resection

Chemotherapy

• Carboplatin (Paraplatin) 175 mg/m² IV once per day on days 0, 7, 14, 21, 42, 49, 56, 63
• Vincristine (Oncovin) 1.5 mg/m² (maximum dose of 2 mg) IV once per day on days 0, 7, 14, 21, 28, 35, 42, 49, 56, 63

10-week course

Subsequent treatment

• CV maintenance

Regimen variant #2, 550/1.5 (uncapped vincristine)

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Gnekow et al. 2017 (SIOP-LCG 2004)	2004-2012	Phase 3 (C)	VCE	Did not meet primary endpoint of PFS

Preceding treatment

• Biopsy or incomplete resection

Chemotherapy

• Carboplatin (Paraplatin) 550 mg/m² IV over 60 minutes once on day 1
• Vincristine (Oncovin) as follows:
  • Cycles 1 to 4: 1.5 mg/m² IV once per day on days 1, 8, 15
  • Cycles 5 to 7: 1.5 mg/m² IV once on day 1

21-day cycle for 4 cycles, then 28-day cycle for 3 cycles

Subsequent treatment

• CV consolidation

References

1. Packer RJ, Lange B, Ater J, Nicholson HS, Allen J, Walker R, Prados M, Jakacki R, Reaman G, Needles MN, Phillips PC, Ryan J, Boyett JM, Geyer R, Finlay J. Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol. 1993 May;11(5):850-6. link to original article contains dosing details in manuscript PubMed
2. COG A9952: Ater JL, Zhou T, Holmes E, Mazewski CM, Booth TN, Freyer DR, Lazarus KH, Packer RJ, Prados M, Sposto R, Vezina G, Wisoff JH, Pollack IF. Randomized study of two chemotherapy regimens for treatment of low-grade glioma in young children: a report from the Children's Oncology Group. J Clin Oncol. 2012 Jul 20;30(21):2641-7. Epub 2012 Jun 4. link to original article link to PMC article contains dosing details in manuscript PubMed Clinical Trial Registry
3. SIOP-LGG 2004: Gnekow AK, Walker DA, Kandels D, Picton S, Perilongo G, Grill J, Stokland T, Sandstrom PE, Warmuth-Metz M, Pietsch T, Giangaspero F, Schmidt R, Faldum A, Kilmartin D, De Paoli A, De Salvo GL; of the Low Grade Glioma Consortium and the participating centers. A European randomised controlled trial of the addition of etoposide to standard vincristine and carboplatin induction as part of an 18-month treatment programme for childhood (≤16 years) low grade glioma - a final report. Eur J Cancer. 2017 Aug;81:206-225. Epub 2017 Jun 22. Erratum in: Eur J Cancer. 2017 Dec 13;:. link to original article link to PMC article contains dosing details in manuscript PubMed

Recurrent or progressive, non-curative therapy

Cisplatin & Etoposide (EP)

Regimen

Study	Evidence
Massimino et al. 2010	Non-randomized

Note: In children less than 1 year old or less than 10 kg, "doses were adjusted to their weight"--reference does not say exactly how doses are adjusted.

Chemotherapy

• Cisplatin (Platinol) 25 mg/m² IV over 2 hours once per day on days 1 to 3, given first
• Etoposide (Vepesid) 100 mg/m² IV over 30 minutes once per day on days 1 to 3, given second

Supportive therapy

• Hydration for 2 hours before chemotherapy, and for 2 hours after chemotherapy

28-day cycle for 4 cycles, then 35-day cycle for 3 cycles, then 42-day cycle for 3 cycles

References

1. Massimino M, Spreafico F, Riva D, Biassoni V, Poggi G, Solero C, Gandola L, Genitori L, Modena P, Simonetti F, Potepan P, Casanova M, Meazza C, Clerici CA, Catania S, Sardi I, Giangaspero F. A lower-dose, lower-toxicity cisplatin-etoposide regimen for childhood progressive low-grade glioma. J Neurooncol. 2010 Oct;100(1):65-71. Epub 2010 Feb 12. link to original article contains dosing details in manuscript PubMed

Temozolomide monotherapy

Regimen variant #1

Study	Dates of enrollment	Evidence
Nicholson et al. 2007	1998-1999	Non-randomized

Note: This dosing is for patients who previously received craniospinal irradiation (CSI).

Chemotherapy

• Temozolomide (Temodar) 180 mg/m² PO once per day on days 1 to 5

28-day cycle for 11 cycles

Regimen variant #2

Study	Dates of enrollment	Evidence
Nicholson et al. 2007	1998-1999	Non-randomized

Chemotherapy

• Temozolomide (Temodar) 200 mg/m² PO once per day on days 1 to 5

28-day cycle for 11 cycles

References

1. Nicholson HS, Kretschmar CS, Krailo M, Bernstein M, Kadota R, Fort D, Friedman H, Harris MB, Tedeschi-Blok N, Mazewski C, Sato J, Reaman GH; Children's Oncology Group. Phase 2 study of temozolomide in children and adolescents with recurrent central nervous system tumors: a report from the Children's Oncology Group. Cancer. 2007 Oct 1;110(7):1542-50. link to original article contains dosing details in manuscript PubMed