Prolonged response to oral gefitinib, cyclophosphamide, and topotecan in heavily pretreated relapsed stage 4 neuroblastoma: a case report.
A girl with metastatic neuroblastoma diagnosed at 4 years of age experienced an early disseminated relapse after high-dose chemotherapy. After reinduction, compassionate treatment with gefitinib (250 mg/d fixed dose) with oral topotecan (0.8 mg/m(2)/d) and cyclophosphamide (50 mg/m(2)/d) for 14 consecutive days, each course repeated every 28 days, was administered. Complete marrow clearance and metaiodobenzylguanidine response were achieved after 4 courses. After the first course, topotecan and cyclophosphamide were reduced by 25% for grade 4 hematologic toxicity. Subsequent courses were well tolerated. The girl remained progression free for 27 months. This combination may represent a viable therapeutic option and deserves further evaluation in resistant neuroblastoma.
Donfrancesco
Alberto
A
Division of Pediatric Oncology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy. donfrancesco@opbg.net
Jenkner
Alessandro
A
De Ioris
Maria Antonietta
MA
Ilari
Ilaria
I
Castellano
Aurora
A
De Laurentis
Clementina
C
Garganese
Maria Carmen
MC
Milano
Giuseppe Maria
GM
Dominici
Carlo
C
D000284:Administration, Oral; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005260:Female; D000077156:Gefitinib; D006801:Humans; D009447:Neuroblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011799:Quinazolines / Q000008:administration & dosage*; D011877:Radionuclide Imaging; D012008:Recurrence; D019772:Topotecan / Q000008:administration & dosage*; D016896:Treatment Outcome
D011799:Quinazolines; D019772:Topotecan; D003520:Cyclophosphamide; D000077156:Gefitinib