Randomized Study of Two Chemotherapy Regimens for Treatment of Low-Grade Glioma in Young Children: A Report From the Children's Oncology Group

Ater, Joann L.; Zhou, Tianni; Holmes, Emi; Mazewski, Claire; Booth, Timothy N.; Freyer, David R.; Lazarus, Ken H.; Packer, Roger J.; Prados, Michael D.; Sposto, Richard; Vézina, Gilbert; Wisoff, Jeffrey H.; Pollack, Ian F.

doi:10.1200/jco.2011.36.6054

Cited by 373 publications

(336 citation statements)

References 32 publications

(10 reference statements)

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“…7,[32][33][34][35][36] Indeed, many of these patients experience multiple tumor progressions, and upfront aggressive treatment options such as radiation therapy are being used to avoid potential patient demise. Despite multiple progressions, we observed >90% survival 20 to 25 years after the diagnosis in the absence of aggressive modalities such as radiotherapy and no late mortality due to tumor progression.…”

Section: Discussionmentioning

confidence: 99%

Clinical and treatment factors determining long‐term outcomes for adult survivors of childhood low‐grade glioma: A population‐based study

Krishnatry

Zhukova

Stücklin

et al. 2016

Cancer

124

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BACKGROUND:The determinants of outcomes for adult survivors of pediatric low-grade glioma (PLGG) are largely unknown. METH-ODS: This study collected population-based follow-up information for all PLGG patients diagnosed in Ontario, Canada from 1985 to 2012 (n 5 1202) and determined factors affecting survival. The impact of upfront radiation treatment on overall survival (OS) was determined for a cohort of Ontario patients and an independent reference cohort from the Surveillance, Epidemiology, and End Results database. RESULTS: At a median follow-up of 12.73 years (range, 0.02-33 years), only 93 deaths (7.7%) were recorded, and the 20-year OS rate was 90.1% 6 1.1%. Children with neurofibromatosis type 1 had excellent survival and no tumor-related deaths during adulthood. Adverse risk factors included pleomorphic xanthoastrocytoma (P <.001) and a thalamic location (P <.001). For patients with unresectable tumors surviving more than 5 years after the diagnosis, upfront radiotherapy was associated with an approximately 3-fold increased risk of overall late deaths (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.6-6.6; P 5.001) and an approximately 4-fold increased risk of tumor-related deaths (HR, 4.4; 95% CI, 1.3-14.6; P 5.013). In a multivariate analysis, radiotherapy was the most significant factor associated with late all-cause deaths (HR, 3.0; 95% CI, 1.3-7.0; P 5.012) and tumor-related deaths (HR, 4.4; 95% CI, 1.3-14.6; P 5 0.014). A similar association between radiotherapy and late deaths was observed in the independent reference cohort (P <.001). In contrast to early deaths, late mortality was associated not with PLGG progression but rather with tumor transformation and non-oncological causes. CONCLUSIONS: The course of PLGG is associated with excellent long-term survival, but this is hampered by increased delayed mortality in patients receiving upfront radiotherapy. These observations should be considered when treatment options are being weighed for these patients. Cancer 2016;122:1261-9.

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Section: Discussionmentioning

confidence: 99%

Clinical and treatment factors determining long‐term outcomes for adult survivors of childhood low‐grade glioma: A population‐based study

Krishnatry

Zhukova

Stücklin

et al. 2016

Cancer

124

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“…The five-year EFS rates were 39 AE 4 percent for CV and 52 AE 5 percent for TPCV. However, this difference in EFS was not statistically significant and the TPCV regimen was associated with increased toxicity (12). Other agents that have been explored include vinblastine, temozolomide, bevacizumab and irinotecan, cisplatin, and etoposide resulting in EFS ranging from 34 percent to 78 percent (reviewed in (13).…”

Section: Current Chemotherapy Approachesmentioning

confidence: 99%

Past and future challenges for the clinical care of children with low-grade gliomas

Mueller¹

2015

AACR Education book

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“…Due to the debilitating effects of RT on growth and neurological development, chemotherapy is commonly employed in young children to delay RT [4] [5]. A number of chemotherapy regimens have been tested, including carboplatin and vincristine as well as, nitrosourea-based multiagent regimens including procarbazine, 6-thioguanine, dibromodulcitol, lomustine and vincristine, and single agent temozolomide [4] [5] [6] [7].…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, based on the most recent studies, the traditional regimen with carboplatin and vincristine introduced 19 years ago still provides the best results [7]. There is no doubt that chemotherapy has been successful in stabilizing disease and delaying inevitable radiation therapy and death from tumor progression.…”

Section: Introductionmentioning

confidence: 99%

A Phase II Study of Antineoplastons A10 and AS2-1 in Children with Low-Grade Astrocytomas—Final Report (Protocol BT-13)

Burzynski¹,

Janicki²,

Burzynski³

2016

JCT

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Nonresectable Low-Grade Astrocytomas (LGA) can compromise function and threaten life. For the majority of patients, the most appropriate strategy is initial chemotherapy followed by Radiation Therapy (RT). Since curative treatment is not available for most of these patients, it is reasonable to conduct clinical studies to evaluate new agents. This Phase II study evaluates efficacy and safety of Antineoplastons A10 and AS2-1 (ANP) in LGA. Sixteen children diagnosed with LGA were treated. They included 12 males and 4 females, ages 1.6 -17.4 years (median 10.6). Efficacy was evaluated in 16 patients. The majority of patients were previously treated, but 1 patient had stereotactic biopsy only. Out of the remaining 15 patients, 6 patients received chemotherapy, and 7 patients had surgery, and 2 patients received RT and chemotherapy after surgery. The patients received treatment with ANP administered daily every 4 hours (median dose of A10 was 7.71 g/kg/d and AS2-1 was 0.26 g/kg/d) until objective response or stable disease was documented and for 8 months thereafter. The duration of ANP IV ranged from 1.4 to 286 weeks with a median of 83 weeks. A complete response was documented in 25.0%, partial response in 12.5%, and stable disease in 37.5%. Overall survival was 67.7% at 5 years, and 54.2% at 10 and 15 years. Progression-free survival was 48.1%, 34.4% and 34.4% at 5, 10, and 15 years respectively. The treatment was associated with grade 3 or grade 4 Adverse Drug Experiences (ADE) in 6 patients. There were two hypernatremias of grade 4 (12%). Grade 3 ADE included urinary frequency (6%), fatigue (6%) and hypernatremia (6%). There were no chronic toxicities, and there was a high quality of survival. ANP shows efficacy with a very good toxicity profile in this cohort of children with low-grade astrocytoma.

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Randomized Study of Two Chemotherapy Regimens for Treatment of Low-Grade Glioma in Young Children: A Report From the Children's Oncology Group

Cited by 373 publications

References 32 publications

Clinical and treatment factors determining long‐term outcomes for adult survivors of childhood low‐grade glioma: A population‐based study

Clinical and treatment factors determining long‐term outcomes for adult survivors of childhood low‐grade glioma: A population‐based study

Past and future challenges for the clinical care of children with low-grade gliomas

A Phase II Study of Antineoplastons A10 and AS2-1 in Children with Low-Grade Astrocytomas—Final Report (Protocol BT-13)

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