Chemotherapy with vincristine (VCR) and etoposide (VP-16) in children with low-grade astrocytoma

Abstract

Twenty patients, aged 6 months to 20 years, with low-grade astrocytoma (LGA) participated in a chemotherapy trial of vincristine (VCR) and etoposide (VP-16). Fourteen children had recurrent progressive disease at entry on study. Prior treatment consisted of surgical resection alone (6), surgical resection and irradiation (4), surgical resection, irradiation and chemotherapy (2), surgery and chemotherapy (1), and irradiation and chemotherapy (1). Six patients were treated at initial diagnosis of LGA because they were less than 5 years old (5) or for a second primary tumor (1). Four recurrent patients and 3 newly diagnosed patients underwent surgical debulking of their tumors immediately prior to study entry. Tumors were located in the optic nerve/chiasm/hypothalamus (8), brain stem/cerebellum (4), cerebral hemispheres (3), midline structures (3), and spinal cord (2). The treatment plan administered in an out-patient setting consisted of weekly VCR 1.5 mg/m2 for 7 to 8 weeks and VP-16 100 mg/m2 for 5 days repeated every 6 weeks for a total of 18 months of therapy. Responses were evaluated by computerized tomography or magnetic resonance imaging. Of the 20 patients, 1 exhibited a partial response maintained for 12+ months, 3 exhibited minor responses maintained for a period of 10+ to 35 months, and 11 maintained stable disease for 10 to 42 months. Of the 11 patients with stable disease, 2 were withdrawn early from the study without further therapy. Five of the 20 patients developed progressive disease; for 4 of these 5, this occurred during the first course of therapy. Subsequently, these 5 died due to tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome of children with centrally reviewed low‐grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high‐grade glioma study CCG‐945

“…Agents that have been used include actinomycin D, 8 vincristine, 9 carmustine, 10 carboplatin, [11][12][13] and etoposide. 14,15 The most successful regimens have used carboplatin and vincristine, resulting in a 3-year progression-free survival (PFS) rate of 68% Ϯ 7%, 3 and procarbazine, 6-thioguanine, dibromodulcitol, lomustine, and vincristine, resulting in a 5-year overall survival (OS) rate of 78%. 16 In the current article, we report the outcomes and clinical characteristics of 70 patients who were diagnosed initially with high-grade glioma, subsequently treated with chemotherapy and radiotherapy according to the Children's Cancer Group (CCG) high-grade glioma protocol (CCG-945), and later shown to have had low-grade glioma after central review of pathology using contemporary classification criteria.…”

Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

“…A variety of drugs have been used, including vincristine, actinomycin D, etoposide, carmustine, and carboplatin, as well as combination regimens consisting of these drugs (R. Prados, personal communication, 1996). [5,14,17,18,20,21,24] In 1989, a study was begun to evaluate the efficacy of combining carboplatin and vincristine in treating children with recurrent and newly diagnosed astrocytomas. The objective response rates of 60 children, including 37 with newly diagnosed astrocytomas, have been reported.…”

Optic glioma warranting treatment in children

“…Carboplatin, cisplatin, vincristine, vinblastine, actinomycin D, lomustine, thioguanine, procarbazine, dibromodulcitol, etoposide, tamoxifen, and temozolomide, alone or in combination, as primary treatment or as adjuvant, have all been utilized. [10][11][12][13]19,[32][33][34][35][36][37][38][39][40] Although chemotherapy has emerged as promising therapy, no regimen has yet to be universally accepted, hence the current Children's Oncology Group trial.…”