Reactions 1479, p6-7 - 23 Nov 2013

SAntineoplastics

Neutropenia and other toxicities in children: 6 casereports

Four girls and two boys, aged 3.5–10.6 years, wereidentified from a retrospective chart review after theydeveloped neutropenia and/or other toxicities while receivingantineoplastics for diffuse intrinsic pontine glioma [times toreaction onsets and some outcomes not stated].

Five patients initially received radiotherapy concomitantlywith IV carboplatin 35 mg/m2/day and oral etoposide50 mg/m2/day for 21 days every 28 days, while one patientreceived oral temozolomide 90 mg/m2/day for 42 days duringradiotherapy. After chemoradiotherapy, all of the patientsreceived maintenance therapy with oral temozolomide75 mg/m2/day from Monday–Friday continuously,bevacizumab 15 mg/kg/dose every 3 weeks [routes not stated]and infusions of irinotecan 125 mg/m2 weekly for either2 weeks with a 1-week break or 4 weeks with a 2-week break.Maintenance therapy was continued for 4–11 cycles untildisease progression.

During chemoradiotherapy, four patients developedgrade III or IV neutropenia; they received filgrastim as part oftheir management. Two patients had no complications duringchemoradiotherapy. Five patients developed complicationsduring maintenance chemotherapy. Grade III neutropeniarequiring dose reduction occurred in four patients and twopatients developed grade II hypertension that was controlledwith monotherapy. Four patients experienced diarrhoea and/or abdominal cramping; one of these patients had grade IIIdiarrhoea requiring emergency department admission fordehydration and hypokalaemia, another developed grade IIabdominal cramping alone during an irinotecan infusion. Onepatient, who had neutropenia, diarrhoea and abdominalcramping, also developed a tumour haemorrhage.

Author comment: "This regimen of chemoradiotherapyfollowed by temozolomide, irinotecan, and bevacizumab inmaintenance showed a slight increase in the [event-freesurvival] and [overall survival] in six patients with [diffuseintrinsic pontine glioma] with moderate but manageabletoxicities compared to ACNS0126 trial."Zaky W, et al. Treatment of children with diffuse intrinsic pontine gliomas withchemoradiotherapy followed by a combination of temozolomide, irinotecan, andbevacizumab. Pediatric Hematology and Oncology 30: 623-632, No. 7, Oct 2013.Available from: URL: http://dx.doi.org/10.3109/08880018.2013.829895 -USA 803095918

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Reactions 23 Nov 2013 No. 14790114-9954/13/1479-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved