Treatment With Oral Etoposide for Childhood Recurrent Ependymomas

Sandri, Alessandro; Massimino, Maura; Mastrodicasa, Luana; Sardi, N.; Bertin, Daniele; Basso, Maria Eleonora; Todisco, L.; Paglino, Alessandra; Perilongo, Giorgio; Genitori, Lorenzo; Valentini, Laura; Ricardi, Umberto; Gandola, Lorenza; Giangaspero, Felice; Madon, E

doi:10.1097/01.mph.0000181430.71176.b7

Cited by 38 publications

(20 citation statements)

References 31 publications

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“…In the only osteosarcoma study on Oral Etoposide 50 mg/m 2 /daily for 14 days as monotherapy, Kebudi et al [7] reported a 15% response rate (RR) in relapsed pediatric patients. Sandri et al [8] reported a successful use of Oral Etoposide at 50 mg/m 2 in children with recurrent ependymomas, showing a 40% RR. Oral Etoposide is well tolerated, with only mild adverse drug reactions like nausea, leucopenia, and alopecia.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Study on Postrelapse Disease‐Free Survival with Adjuvant Mistletoe versus Oral Etoposide in Osteosarcoma Patients

Longhi

Reif

Mariani

et al. 2014

Evidence-Based Complementary and Alternative Medicine

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Background. Osteosarcoma is a highly malignant bone tumour. After the second relapse, the 12-month postrelapse disease-free survival (PRDFS) rate decreases below 20%. Oral Etoposide is often used in clinical practice after surgery as an “adjuvant” outside any protocol and with only limited evidence of improved survival. Viscum album fermentatum Pini (Viscum) is an extract of mistletoe plants grown on pine trees for subcutaneous (sc) injection with immunomodulatory activity. Methods. Encouraged by preliminary findings, we conducted a study where osteosarcoma patients free from disease after second metastatic relapse were randomly assigned to Viscum sc or Oral Etoposide. Our goal was to compare 12-month PRDFS rates with an equivalent historical control group. Results. Twenty patients have been enrolled, with a median age of 34 years (range 11–65) and a median follow-up time of 38.5 months (3–73). The median PRDSF is currently 4 months (1–47) in the Etoposide and 39 months (2–73) in the Viscum group. Patients getting Viscum reported a higher quality of life due to lower toxicity. Conclusion. Viscum shows promise as adjuvant treatment in prolonging PRDFS after second relapse in osteosarcoma patients. A larger study is required to conclusively determine efficacy and immunomodulatory mechanisms of Viscum therapy in osteosarcoma patients.

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Section: Introductionmentioning

confidence: 99%

A Randomized Study on Postrelapse Disease‐Free Survival with Adjuvant Mistletoe versus Oral Etoposide in Osteosarcoma Patients

Longhi

Reif

Mariani

et al. 2014

Evidence-Based Complementary and Alternative Medicine

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“…There was a 2-week gap between cycles. Drug dosing and treatment schedule are based on previously published treatments for children with high-risk neuroblastoma [32], sarcomas and brain tumors [22,30,31,[33][34][35]. No further dose escalation has been planned for this group of patients.…”

Section: Study Design and Therapy Administrationmentioning

confidence: 99%

Combined Biodifferentiating and Antiangiogenic Oral Metronomic Therapy is Feasible and Effective in Relapsed Solid Tumors in Children: Single-Center Pilot Study

et al. 2006

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To outline an outpatient-based treatment for children with relapsed solid tumors, who already have been extensively pretreated, we defined a 4-drug protocol named COMBAT (combined oral maintenance biodifferentiating and antiangiogenic therapy). Using this protocol, we performed a pilot study to determine its feasibility in children with relapsed and/or high-risk pediatric solid tumors. Patients and Methods: 22 children received the COMBAT protocol. Treatment consisted of daily celecoxib administration along with daily 13-cisretinoic acid (2 weeks on / 2 weeks off) and cycles of metronomic temozolomide (90 mg/m2 for 42 days) and low-dose etoposide (21 days). The treatment was scheduled for a period of 1 year. Results: 9 of the 14 patients assessable for response demonstrated evidence of treatment benefit manifested as prolonged disease stabilization or response. The protocol medication was well tolerated with very good compliance. Only minimal side effects where observed which responded to dose modification or local therapy. Conclusions: The COMBAT regimen is well tolerated by patients with intensive prior therapy including myeloablative regimens. Favorable responses observed in this cohort of patients support the further exploration of this and/or similar strategies in the treatment of pediatric solid tumors.

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“…However, Brandes et al found that platinum-based regimes had no effect on overall survival, despite a partial or complete response in 31% [42]. Oral etoposide has also been reported as being able to maintain stable disease for a median of 7 months in a small group of patients with recurrent disease [43].…”

Section: Chemotherapymentioning

confidence: 97%

Recurrent pituitary ependymoma: a complex clinical problem

Belcher¹,

Chahal²,

Evanson³

et al. 2008

Pituitary

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Ependymomas rarely arise from the region of the pituitary fossa, with only four cases previously reported in the literature. We present a complex case of a recurrent ependymoma of the parasellar region which has been difficult to clinically manage due to its tendency to recurrence. Our patient has had four operations over the last 28 years, with external beam radiotherapy, but still has residual tumor and is currently panhypopituitary and with significant visual loss. We believe there is considerable uncertainty as to the optimal management of any future progression, which seems likely, and are currently considering the use of radiosurgery with careful sparing of the optic chiasm, or possibly the chemotherapeutic agent temozolomide. Our case emphasises the recurrent nature of this rare but difficult tumor.

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Treatment With Oral Etoposide for Childhood Recurrent Ependymomas

Cited by 38 publications

References 31 publications

A Randomized Study on Postrelapse Disease‐Free Survival with Adjuvant Mistletoe versus Oral Etoposide in Osteosarcoma Patients

A Randomized Study on Postrelapse Disease‐Free Survival with Adjuvant Mistletoe versus Oral Etoposide in Osteosarcoma Patients

Combined Biodifferentiating and Antiangiogenic Oral Metronomic Therapy is Feasible and Effective in Relapsed Solid Tumors in Children: Single-Center Pilot Study

Recurrent pituitary ependymoma: a complex clinical problem

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