Treatment Outcomes in Children and Adolescents with Relapsed or Progressed Solid Tumors: a 20-year, Single-Center Study

Abstract

BackgroundBy estimating the survival rates and exploring prognostic factors in pediatric patients with relapsed or progressed solid tumors, our purpose was to generate background data for future studies.MethodsWe reviewed the medical records of 258 patients with solid tumors who experienced relapse/progression and received subsequent salvage treatment between 1996 and 2016.ResultsA total of 60 patients remained progression-free during first-line salvage treatment, while the remaining 198 patients experienced relapse/progression again; 149 underwent second-line salvage treatment. A total of 76 patients underwent high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT), and 44 patients received allogeneic SCT. The 10-year progression-free survival (PFS) and overall survival (OS) from relapse/progression were 18.4% ± 2.7% and 24.5% ± 3.0%, respectively. Survival rates were relatively higher in patients with anaplastic ependymoma, initially non-high-risk neuroblastoma, osteosarcoma, Wilms tumor and retinoblastoma. A multivariate analysis showed that relapse/progression during initial treatment, metastatic relapse/progression, and impossible debulking surgery were independent poor prognostic factors for both PFS and OS. Patients who exhibited a complete response or partial response during conventional salvage treatment showed significantly higher survival after SCT than those with stable disease or progressive disease (10-year OS: 54.8% ± 7.0% vs. 7.0% ± 3.5%, P < 0.001).ConclusionThe prognosis of relapsed/progressed pediatric solid tumors still remains unsatisfactory. New, effective treatment strategies are needed to overcome limitations of current approaches. Hopefully, the background data generated herein will be used in future clinical trials involving patients with relapsed/progressed solid tumors.

Survival estimates of childhood malignancies treated at the Mexican telethon pediatric oncology hospital

“…60 Early relapse has also been used to predict survival. 46,[51][52][53] While no such correlation was observed for ALL using 18-month relapse in this study, a moderate correlation was seen between 12-month relapse and survival for TOCNS (r = 0.44) and TWCNS (r = 0.43).…”

“…Based on the HITO model, 1‐year relapse rate was 4.7%, 12.9%, and 16.9% for ALL, TWCNS, and TOCNS, respectively. All patients who relapsed after the first year were given a second‐line treatment with the intention to cure 51–53 . Comparing these results with international studies could not be done, as we followed the Mexican official classification, and combined various diagnoses due to sample size constraints.…”

Avelumab in paediatric patients with refractory or relapsed solid tumours: dose-escalation results from an open-label, single-arm, phase 1/2 trial

“…Treatment of advanced paediatric cancer typically includes cytotoxic chemotherapy; however, patients often develop resistance and have refractory or relapsed disease, resulting in a poor prognosis [ 1 , 2 ]. Immune checkpoint inhibitors (ICIs) that target the PD-L1/PD-1 interaction have been approved as treatments for various adult cancers.…”

Combination Therapy With Anti-PD-1 or PD-1 Antibody Alone in Asian Pediatric Patients With Relapsed or Refractory Cancer

“…For pediatric patients with cancer, the standard treatment includes surgery, nonspecific cytotoxic chemotherapy and radiotherapy ( 1 , 2 ). However, the prognosis for recurrent/progressive solid tumors in children remains unfavorable, with a 10-year OS and PFS of 24.5% and 18.4%, respectively ( 3 ). Thus, novel development approaches for pediatric cancers are urgently needed ( 4 , 5 ).…”