Results of Vincristine, Cyclophosphamide and Topotecan Protocol in Refractory/Relapsed Pediatric Solid Tumors. A Single-Center Experience.

INTRODUCTION: Despite the dramatic progress on treatment of pediatric solid tumors in the last 3 decades, confronting a relapsed or refractory patient is still challenging. We report our experience of refractory/relapsed pediatric solid tumor patients treated with vincristin + topotecan + cyclophosphamide (VTC) as salvage therapy.
METHODS: Eleven refractory/relapsed patients (5 neuroblastoma, 4 Ewing’s sarcoma, 1 rhabdomyosarcoma and 1 osteosarcoma) who were given VTC as a salvage therapy were evaluated. They, all, were metastatic at diagnosis and received appropriate initial chemotherapy. VTC consisted of vincristin (1.5 mg/m2 on day 1), cyclophosphamide (CYC) (600 mg/m2/day with mesna, on days 1 and 2) and topotecan (TOPO) (1 mg/m2/day on days 1, 2 and 3).
RESULTS: Eleven patients received a total of 53 courses of VTC with a median of 4 (range 2-14). Median age at diagnosis was 12 years. One patient achieved CR, 6 patients had SD, and 4 patients had PD after 2 courses of VTC. Median survival duration is 28 months after diagnosis while it is 16 months after relapse. Median survival duration after first VTC is 5 months (2-21 months). Myelosuppression was the primary dose limiting toxicity.
DISCUSSION AND CONCLUSION: We concluded VTC to have a clinically tolerable but non-satisfactory effect on relapsed/refractory solid tumors in children.