Annals of Oncology 13:460-469, 2002
© 2002 European Society for Medical Oncology
Ifosfamide, carboplatin and etoposide in children with poor-risk relapsed Wilms’ tumor: a Children’s Cancer Group report
1Lombardi Cancer Center, Georgetown University, Washington, DC; 2Keck School of Medicine, University of Southern California, Los Angeles, CA and Children’s Oncology Group, Arcadia, CA; 3North Texas Hospital for Children, Dallas, TX; 4Children’s Hospital of New York, Columbia University, New York, NY; 5Medical University of South Carolina, Charleston, SC; 6Children’s National Medical Center, Washington, DC, USA
Received 20 March 2001; revised and accepted 23 August 2001.
Background
The outcome of children with relapsed Wilms’ tumor is poor, especially with poor-risk factors such as unfavorable histology, early recurrence, previous three-drug therapy, relapse not confined to lungs and abdominal relapse following abdominal radiotherapy. We report the overall response rate, progression-free survival and overall survival of 11 children with relapsed and poor-risk Wilms’ tumor following ifosfamide/carboplatin/etoposide (ICE) chemotherapy.
Patients and methods
ICE therapy consisted of ifosfamide 1800 mg/m2/day (on day 0–4), carboplatin 400 mg/m2/day (on day 0–1) and etoposide 100 mg/m2/day (on day 0–4). The median age at diagnosis was 39 months (range from 13 months to 16 years) and the median time to relapse after initial diagnosis was 9 months (range 4–72 months). All but one patient had at least one poor prognostic feature, with eight patients showing three or four.
Results
After ICE chemotherapy the number of patients showing a complete response (CR) was three (27%) and a partial response (PR) was six (55%). The overall response rate (CR+PR) was 82%. Five of the six patients with a PR subsequently achieved a CR with further therapy. The 3-year event-free survival and overall survival were 63.6 ± 14.5%.
Conclusions
The response rate in children with relapsed and poor-risk Wilms’ tumor is >80% with ICE re-induction chemotherapy followed by post-ICE therapy. The optimal approach for post-ICE consolidation therapy has yet to be determined.
Key words: chemotherapy, childhood, recurrent, solid tumors, survival
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