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Single center experience of a new intensive induction therapy for Ewing's family of tumors: Feasibility, toxicity, and stem cell mobilization properties

Strauss, SJ; McTiernan, A; Driver, D; Hall-Craggs, M; Sandison, A; Cassoni, AM; Kilby, A; (2003) Single center experience of a new intensive induction therapy for Ewing's family of tumors: Feasibility, toxicity, and stem cell mobilization properties. Journal of Clinical Oncology , 21 (15) pp. 2974-2981. 10.1200/JCO.2003.04.106.

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Abstract

Purpose: To examine the feasibility, tolerability, and toxicity of an intensified induction regimen (vincristine, ifosfamide, doxorubicin, and etoposide [VIDE]) in patients with newly diagnosed Ewing's family of tumors (EFT); to assess ability to maintain dose-intensity, and predictability of peripheral-blood stem cell mobilization. Patients and Methods: Thirty patients were treated with vincristine 1.4 mg/m (maximum 2 mg) on day 1, doxorubicin 20 mg/m, ifosfamide 3 g/m plus mesna and etoposide 150 mg/m on days 1 to 3. Cycles were given every 21 days for up to six cycles. Results: One-hundred and seventy cycles of VIDE were given. The median treatment interval was 21 days (21 to 42) and nadir count: hemoglobin 8.3 (6.3 to 11.9), neutrophils 0.045 (0.0 to 2.1), and platelets 45 (3 to 343). There were 96 episodes of infection requiring hospitalization (56%). Growth factor support reduced infectious complications by 34%. Etoposide dose was reduced, or omitted, in 24% of cycles. Four patients did not complete six cycles due to unacceptable toxicity and one patient progressed on treatment. Twenty patients underwent peripheral-blood stem cell harvesting, 15 after cycle 3, and five after cycle 4. Median CD34 yield was 4.6 × 10 /kg per patient (1.8 to 14.5). Overall response to treatment, measured in 24 patients, was 88%. Seven of 11 patients undergoing surgery achieved greater than 90% necrosis of tumor (64%). Conclusion: VIDE is an effective induction regimen with substantial but acceptable toxicity that allows predictable mobilization of stem cells. Maintenance of dose-intensity is feasible in the majority of patients. Growth factors play a role in maintaining dose-intensity and reduce infectious complications. © 2003 by American Society of Clinical Oncology.

Type: Article
Title: Single center experience of a new intensive induction therapy for Ewing's family of tumors: Feasibility, toxicity, and stem cell mobilization properties
DOI: 10.1200/JCO.2003.04.106
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of)
URI: http://discovery.ucl.ac.uk/id/eprint/67546
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