What is the role of medications in the treatment of pediatric neuroblastoma?

Updated: Oct 09, 2017
  • Author: Norman J Lacayo, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Answer

All chemotherapy orders are written by pediatric oncologists and countersigned, usually by another physician. With recurrent disease, various salvage protocols may be used; with refractory disease, a limited number of phase I/II studies are available through the Children's Oncology Group (COG) and New Approaches to Neuroblastoma Therapy (NANT) consortia.

Resources presented in this section should serve as a guide to indication, usual dosages, and adverse effects of specific agents. Antineoplastic drugs have a narrow therapeutic index and effective doses usually cause severe toxicities, some of which can be life threatening.

Individual chemotherapy drugs are discussed below. These agents are almost invariably given in combination. Commonly used combinations include the following:

  • Vincristine, cyclophosphamide, and doxorubicin

  • Carboplatin and etoposide

  • Cisplatin and etoposide

  • Ifosfamide and etoposide

  • Cyclophosphamide and topotecan

Consolidation regimens used in neuroblastoma include the following:

  • Carboplatin and etoposide with melphalan or cyclophosphamide

  • Thiotepa and cyclophosphamide

  • Melphalan and total body irradiation

In Europe, several studies have used busulfan with melphalan or cyclophosphamide. One commonly used salvage or relapse therapy regimen is the combination of topotecan and cyclophosphamide. The use or retinoids have been incorporated in maintenance regimens in the posttransplant setting. Irinotecan is also under investigation.


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