Treatment of pediatric high‐grade central nervous system tumors with high‐dose methotrexate in combination with multiagent chemotherapy: A single‐institution experience

Bernstock, Joshua D.; Alva, Elizabeth; Cohen, Joshua L.; Lobbous, Mina; Chagoya, Gustavo; Elsayed, Galal; Orr, Brent A.; Rozzelle, Curtis J.; Rocque, Brandon G.; Blount, Jeffrey P.; Johnston, James M.; Li, Rong; Fiveash, John B.; Dhall, Girish; Reddy, Alyssa; Friedman, Gregory K.

doi:10.1002/pbc.28119

Cited by 5 publications

(2 citation statements)

References 39 publications

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“…In all, 344 articles were excluded after our full‐text screen, with reasons for exclusion provided in Figure 1. In total, 25 studies met inclusion criteria and had extractable data 7,8,20–42 …”

Section: Resultsmentioning

confidence: 99%

Focal versus craniospinal radiation for disseminated atypical teratoid/rhabdoid tumor following favorable response to systemic therapy

Aridgides

Mahajan

Eaton

et al. 2023

Pediatric Blood & Cancer

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Purpose Radiotherapy (RT) is associated with improved survival in atypical teratoid/rhabdoid tumor (ATRT); however, optimal RT delivery is unknown. A meta‐analysis was conducted for disseminated (M+) ATRT receiving focal or craniospinal radiation (CSI). Methods After abstract screening, 25 studies (1995–2020) contained necessary patient, disease, and radiation treatment information (N = 96). All abstract, full text, and data capture were independently double‐reviewed. The corresponding author was contacted for cases of insufficient information. Response to pre‐radiation chemotherapy (N = 57) was categorized as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Univariate and multivariate statistics were performed to investigate survival correlation. Patients with M4 disease were excluded. Results The 2‐ and 4‐year overall survival (OS) was 63.8% and 45.7%, respectively, with a median follow‐up of 2 years (range 0.3–13.5). The median age was 2 years (range 0.2–19.5), and 96% received chemotherapy. On univariate analysis, gross total resection (GTR, p = .0007), pre‐radiation chemotherapy response (p < .001), and high‐dose chemotherapy with stem cell recuse (HDSCT, p = .002) correlated with survival. On multivariate analysis, pre‐radiation chemotherapy response (p = .02) and GTR (p = .012) retained survival significance as compared to a trend for HDSCT (p = .072). Comparisons of focal RT (vs. CSI) and greater than or equal to 5400 cGy primary dose were nonsignificant. Following CR or PR, a statistical trend favored focal radiation (p = .089) over CSI. Conclusion Chemotherapy response prior to RT and GTR correlated with improved survival on multivariate analysis for ATRT M+ receiving RT. No benefit was observed for CSI compared to focal RT among all patients and following favorable chemotherapy response, inviting further study of focal RT for ATRT M+.

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Section: Resultsmentioning

confidence: 99%

Focal versus craniospinal radiation for disseminated atypical teratoid/rhabdoid tumor following favorable response to systemic therapy

Aridgides

Mahajan

Eaton

et al. 2023

Pediatric Blood & Cancer

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“…Of the 2701 articles retrieved in the search, 44 studies with IPD on 298 patients with pineoblastoma were included in the systematic review ( Table 1 ) [ 5 , 6 , 8 , 9 , 10 , 11 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Figure 1 presents the PRISMA flowchart for this systematic review [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

Post-Surgical Prognosis of Patients with Pineoblastoma: A Systematic Review and Individual Patient Data Analysis with Trends over Time

Nandoliya,

Sadagopan,

Thirunavu

et al. 2023

Cancers

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Most of the literature on pineoblastoma consists of case reports and single-institution series. The goal of this systematic review and individual patient data (IPD) analysis was to summarize the existing literature, identify factors associated with overall survival (OS), and provide a contemporary update on prognosis for patients with pineoblastoma. Forty-four studies were identified with 298 patients having IPD. Kaplan–Meier analyses were used to report survival outcomes based on age, tumor metastases, extent of resection (EOR), adjuvant therapy, and publication year. Cox regression was performed to identify independent predictors of time to mortality. Multivariable recursive partitioning analysis was used to identify the most important subgroups associated with mortality. Patients were classified based on publication year before and after the last systematic review on this topic (pre-2012 and 2012 onwards) and compared using univariate and multivariable analyses. This study demonstrates that EOR less-than-gross total resection, metastatic presentation, adjuvant chemotherapy without radiation, and tumor presentation in children less than three years old are associated with poorer prognosis. Since 2012, the 5-year actuarial OS has improved from 32.8% to 56.1%, which remained significant even after accounting for EOR, age, and adjuvant therapy. Pineoblastoma remains a severe rare disease, but survival outcomes are improving.

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Folate Antagonists

Gennarini¹,

Cole²,

Bertino³

2022

Holland‐Frei Cancer Medicine

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Overview Folic acid antagonists (antifols) are cytotoxic drugs used as antineoplastic, antimicrobial, anti‐inflammatory, and immune‐suppressive agents. While several folate antagonists have been developed, methotrexate (4‐amino‐4‐deoxy‐10‐ N ‐methyl‐pteroylglutamic acid, MTX) is the antifol with the most extensive history and widest spectrum of use. MTX remains an essential drug in curative chemotherapy regimens used to treat patients with acute lymphoblastic leukemia, osteosarcoma, and choriocarcinoma, and is an important agent in the therapy of patients with lymphoma, breast cancer, bladder cancer, and head and neck cancer. In addition, it is used for patients with nonmalignant diseases such as rheumatoid arthritis, psoriasis, autoimmune diseases, and graft‐versus‐host disease. This article will review the clinical use of and metabolism of MTX and discuss structurally related folate antagonists that have been developed to overcome resistance or have alternate intracellular targets.

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Treatment of pediatric high‐grade central nervous system tumors with high‐dose methotrexate in combination with multiagent chemotherapy: A single‐institution experience

Cited by 5 publications

References 39 publications

Focal versus craniospinal radiation for disseminated atypical teratoid/rhabdoid tumor following favorable response to systemic therapy

Focal versus craniospinal radiation for disseminated atypical teratoid/rhabdoid tumor following favorable response to systemic therapy

Post-Surgical Prognosis of Patients with Pineoblastoma: A Systematic Review and Individual Patient Data Analysis with Trends over Time

Folate Antagonists

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