title: Prohibitive toxicity of a dose-intense regime for metastatic neuroblastoma containing ifosfamide, doxorubicin and cisplatin.
abstract: Three patients with stage 4 neuroblastoma were treated with a schedule comprising alternating modules of myelosuppressive (ifosfamide, etoposide, doxorubicin) and less myelosuppressive (vincristine, cisplatin) drugs given every 10 days regardless of the neutrophil count. A partial response was seen in two patients, and a very good partial response, in one patient. Extensive blood-component support was required. Non-haemopoietic toxicity was severe and led to treatment delays in two patients. Ifosfamide-related encephalopathy was seen in one patient and nephrotoxicity, in two patients. Mucositis was severe in two patients, may have contributed to the high rate of sepsis observed, and precluded the use of doxorubicin in one patient. As ifosfamide and doxorubicin were felt to be responsible for much of the toxicity, a subsequent schedule did not include these agents.
authors.affiliation: Department of Child Health, University of Newcastle upon Tyne, U.K.
authors.forename: S P
authors.initials: SP
authors.lastname: Lowis
authors.forename: A D
authors.initials: AD
authors.lastname: Pearson
authors.forename: M M
authors.initials: MM
authors.lastname: Reid
authors.forename: A W
authors.initials: AW
authors.lastname: Craft
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000139:chemically induced; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007223:Infant; D007413:Intestinal Mucosa / Q000187:drug effects; D007674:Kidney Diseases / Q000139:chemically induced*; D009447:Neuroblastoma / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D018805:Sepsis / Q000150:complications; D014552:Urinary Tract Infections / Q000150:complications; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide