Redefining the role of doxorubicin for the treatment of children with hepatoblastoma. J Clin Oncol 2008 May 10;26(14):2379-83
Date
05/10/2008Pubmed ID
18467729Pubmed Central ID
PMC4558624DOI
10.1200/JCO.2006.09.7204Scopus ID
2-s2.0-44249119869 (requires institutional sign-in at Scopus site) 65 CitationsAbstract
PURPOSE: Systemic chemotherapy has improved the survival of patients with hepatoblastoma (HB). INT-0098 Intergroup Liver Tumor Study demonstrated that patients with HB treated with either cisplatin/fluorouracil/vincristine (CFV) or cisplatin/doxorubicin (CD) had a similar survival. The Children's Oncology Group adopted the less toxic CFV as the standard regimen for treating HB. However, international cooperative groups still favor the CD combination. We therefore decided to revisit the role of doxorubicin for the treatment of HB.
METHODS: Outcomes of patients with HB on the INT-0098 study were reviewed with an emphasis on the postevent survival time for both regimens to elucidate the role of doxorubicin in their retrieval.
RESULTS: Sixty-four of the 173 randomly assigned patients had an event. Of these, 55 experienced progression or recurrence after initial treatment. Eleven (31%) of 36 patients treated with CFV were successfully retrieved with a doxorubicin-containing regimen and surgery and remain alive at last contact, whereas only one (6%) of 18 patients treated with CD was alive after retrieval therapy.
CONCLUSION: CFV is effective for stage I or II HB. Doxorubicin can be omitted as part of initial therapy in the majority of these patients, potentially limiting the long-term cardiac toxicities, without compromising outcome. Doxorubicin is effective in rescuing patients with recurrent disease after CFV and should be incorporated as a means of intensifying initial therapy for advanced-stage, nonmetastatic HB. Outcome of patients with metastatic disease at diagnosis is poor, and improving their survival will require new therapeutic approaches.
Author List
Malogolowkin MH, Katzenstein HM, Krailo M, Chen Z, Quinn JJ, Reynolds M, Ortega JAMESH terms used to index this publication - Major topics in bold
Antineoplastic Combined Chemotherapy ProtocolsChild
Cisplatin
Combined Modality Therapy
Disease-Free Survival
Doxorubicin
Drug Administration Schedule
Fluorouracil
Hepatoblastoma
Humans
Infusions, Intravenous
Liver Neoplasms
Treatment Outcome
Vincristine
