Low-Dose Chemotherapy With Vinblastine and Methotrexate in Childhood Desmoid Tumors

Abstract

With great interest, we read the report by Skapek et al 1 in the September 1998 issue of the Journal of Clinical Oncology. This report detailed 10 cases of recurrent desmoid tumor in children treated with combination therapy of vinblastine and methotrexate. We report five additional cases successfully treated with a regimen similar to that of Skapek et al. Currently, none of our patients has evidence of regrowth of their tumor 7 to 76 months after elective cessation of chemotherapy.Between 1990 and 1997, five boys aged 7 to 17 years with biopsy-proven desmoid tumors were referred to us because the tumors were not amenable to surgical resection or because amputation was considered after multiple courses of surgery had failed. Although desmoid tumors do not show neoplastic features in histologic sections, the use of high-dose radiotherapy or aggressive polychemotherapy vinblastine [VBL], dactinomycin, and cyclophosphamide 2 is commonly advocated in these situations. Similar to Skapek et al, concerns about the toxicity profile and quality of life associated with these types of therapy, especially in prepubertal children, led us to a low-dose chemotherapeutic regimen of VBL and methotrexate (MTX), as previously reported in eight adults. 3 The apparent advantage of this regimen is the minimal risk for acute and long-term toxicities. We administered both VBL (6 mg/m 2 ) and MTX (30 mg/m 2 ) by intravenous push once a week. The total duration of treatment was 12 months, provided that the mass did not grow during that interval. Two patients experienced complete responses, one patient had a partial response, one patient had a minor response, and one patient had stable disease (Table 1). Follow-up after completion of therapy was 7 to 76 months. Tumor regression after VBL/MTX was slow (2 to 6 months) and was preceded by softening of the tumor, first notable after several weeks of treatment. These observations are consistent with the slow growth of the tumor; therefore, the presence of persistent disease immediately after VBL/MTX should not be misconstrued as an indicator of treatment failure. Side effects, including nausea, vomiting, and moderate hair loss, were minor and never required dosage reduction. Tumor recurrence observed in one patient (patient no. 4) was successfully re-treated with another course of VBL/MTX, and complete remission was achieved after 4 weeks.On the basis of our observations and those of Skapek et al, we agree that low-dose VBL/MTX should be considered in children with unresectable or multiply recurrent desmoid tumor who would otherwise require ablative surgery. At present, we do not know how many children will experience definitive cure with low-dose VBL/MTX chemotherapy. However, remission occurs for prolonged periods of time, and even recurrence can be successfully re-treated. In any event, the VBL/MTX combination offers the chance, as pointed out by Skapek et al, to treat young patients with minimal morbidity until they complete puberty. If recurrence occurs at that time, radiation can be expe...

Aggressive fibromatosis in children and adolescents

“…[9][10][11] Various alternative systemic strategies have been explored, including the use of chemotherapy and noncytotoxic agents (ie, hormone therapy, anti-inflammatory agents, interferon alfa [IFN-a]). [12][13][14][15] Other open questions relating to treatment strategy concern the possibility of a no-treatment approach for patients who have nonevolving disease and the search for prognostic indicators for the purpose of patient risk stratification. 16 To contribute new information on the clinical behavior and response to treatment in childhood AF (because there are only reports on small series), we analyzed 94 children and adolescents with AF and focused particularly on the role of systemic treatment.…”

Pediatric aggressive fibromatosis

“…18 According to our current review of all patients with pediatric AF who were treated with chemotherapy only, 25% of patients achieved a CR, and 34% of patients achieved a PR in 34, based mainly on a combination of MTX and vinblastine (VBL), or VAC (Table 5). 5,6,9,11,12 The outcomes of 46 pediatric patients with primary positive margins (SP) suggest that there is an advantage for patients who received adjuvant chemotherapy (n ϭ 8 patients) compared with patients who did not receive adjuvant treatment (n ϭ 38 patients), with a decrease in the disease recurrence rate from 74% to 50% (Table 4). However, the numbers of patients were small and were derived from different series.…”

“…11 Based on the experience of others, it has been suggested that the response of pediatric AF to chemotherapy is slow, and it has been suggested that treatment should be continued for prolonged periods from 12 months to 18 months. 3,9,11 The chronic and prolonged course that many of these children with AF endure as a result of these slow growing lesions suggests that the use of noncytotoxic drugs, such as antiestrogens, non- steroidal antiinflammatory drugs (NSAIDs), imatinib mesylate, interferon-␣, and retinoic acid, for part of their treatment is reasonable. 18,34 -37 Treatment with a well tolerated combination of antiestrogens and NSAIDs was reported to result in tumor reduction and SD in adult and pediatric patients with sporadic AF.…”

“…In total, 32 of 187 pediatric patients were treated with chemotherapy only at the time of initial diagnosis (n ϭ 6 patients), with chemotherapy at the time of disease recurrence (n ϭ 17 patients), or with preoperative chemotherapy (n ϭ 9 patients), and information regarding response was available (Table 5). 5,6,9,11,12 A combination of VBL and MTX was the most commonly reported regimen. Among the patients who received chemotherapy only, the response was a CR in 25% of patients, a PR in 34% of patients, SD in 25% of patients, and PD in 9% of patients, and response was not reported in 6% of patients.…”

An examination of the antibacterial, antifungal, anti-Giardial and anticancer properties of Kigelia africana fruit extracts

“…The antitumour agents vinblastine and vincristine (derived from Catharanthus roseus) are currently used in the treatment of a variety of tumours. [2,3] The medicinal properties of other African plant species are less well understood despite a long history of ethnobotanical usage.…”