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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; ... Whelan, JS; + view all (2003) Single center experience of a new intensive induction therapy for Ewing's family of tumors: Feasibility, toxicity, and stem cell mobilization properties. J CLIN ONCOL , 21 (15) 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(2) (maximum 2 mg) on day 1, doxorubicin 20 mg/m(2), ifosfamide 3 g/m(2) plus mesna and etoposide 150 mg/m(2) 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 x 10(6)/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.

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
Keywords:COMBINED-MODALITY THERAPY, TERM-FOLLOW-UP, YOUNG-ADULTS, MULTIMODAL THERAPY, PROGNOSTIC-FACTORS, SOLID TUMORS, SARCOMA, BONE, CHEMOTHERAPY, CHILDREN
UCL classification: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 > Wolfson Institute and Cancer Institute Administration > Cancer Institute > Research Department of Oncology

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