title: 5-day/5-drug myeloablative outpatient regimen for resistant neuroblastoma.
abstract: 5-day/5-drug (5D/5D) is a novel high-dose regimen administered with autologous hematopoietic SCT (HSCT). It was designed to maximize cytoreduction via high dosing of synergistically interacting agents, while minimizing morbidity in patients with resistant neuroblastoma (NB) and ineligible for clinical trials due to myelosuppression from previous therapy. 5D/5D comprises carboplatin 500 mg/m(2)/day on days 1-2, irinotecan 50 mg/m(2)/day on days 1-3, temozolomide 250 mg/m(2)/day on days 1-3, etoposide 200 mg/m(2)/day on days 3-5 and cyclophosphamide 70 mg/kg/day on days 4-5. HSCT is on day 8. Sixteen patients received 21 courses. Treatment was in the outpatient clinic. Responses were noted against progressive disease (PD) that had developed while patients were off, or receiving only low-dose, chemotherapy but not against PD that emerged despite high-dose chemotherapy. Responses were also seen in patients with PD or stable disease after (131)I-metaiodobenzylguanidine therapy. Grade 3 toxicities were limited to transient elevations in liver enzymes (three courses) and hyponatremia (one course). Bacteremia occurred in 2/21 (10%) courses. Hematological recovery allowed patients to be enrolled on clinical trials. In conclusion, 5D/5D (including HSCT) spares vital organs, entails modest morbidity, shows activity against resistant NB and helps patients meet eligibility requirements for formal clinical trials.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. kushnerb@mskcc.org
authors.forename: B H
authors.initials: BH
authors.lastname: Kushner
authors.forename: S
authors.initials: S
authors.lastname: Modak
authors.forename: K
authors.initials: K
authors.lastname: Kramer
authors.forename: E M
authors.initials: EM
authors.lastname: Basu
authors.forename: S S
authors.initials: SS
authors.lastname: Roberts
authors.forename: N-Kv
authors.initials: NK
authors.lastname: Cheung
mesh_terms: D019797:3-Iodobenzylguanidine; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077146:Irinotecan; D008297:Male; D009447:Neuroblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D010045:Outpatients; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D000077204:Temozolomide
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D005047:Etoposide; D000077146:Irinotecan; D003606:Dacarbazine; D003520:Cyclophosphamide; D016190:Carboplatin; D002166:Camptothecin; D000077204:Temozolomide