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Irinotecan and temozolomide chemotherapy in paediatric and adult populations with relapsed Ewing Sarcoma
Insights
Irinotecan and temozolomide (IT) chemotherapy shows activity in relapsed Ewing sarcoma for both pediatric and adult patients, with similar toxicity and response rates. Pediatric patients experienced superior progression-free survival (PFS).
Area of Science:
- Pediatric Oncology
- Medical Oncology
- Sarcoma Research
Background:
- Irinotecan and temozolomide (IT) is a standard chemotherapy regimen for relapsed Ewing sarcoma (ES).
- Previous studies on IT for ES have primarily focused on pediatric populations.
- The efficacy and safety of IT in adult patients with relapsed ES remain less understood.
Purpose of the Study:
- To evaluate the efficacy and toxicity of salvage irinotecan and temozolomide (IT) chemotherapy in both pediatric and adult patients with relapsed Ewing sarcoma (ES).
- To compare treatment outcomes, including response rates and progression-free survival (PFS), between pediatric and adult cohorts receiving IT.
- To assess the safety profile of IT, focusing on hematologic toxicities and other adverse events.
Main Methods:
- Retrospective review of pediatric (<18 years) and adult (≥18 years) patients treated with salvage IT at two institutions.
- Grading of hematologic toxicities using common terminology criteria for adverse events (CTCAE).
- Survival outcomes, including PFS, were estimated using the Kaplan-Meier method and compared with the Log Rank test.
Main Results:
- A total of 53 patients (16 pediatric, 37 adult) received salvage IT between 2010 and 2018.
- No significant difference in grade 3/4 hematologic toxicity (31% pediatric vs. 35% adult) or any-grade diarrhea (38% in both groups) was observed.
- Objective response rate was similar between pediatric (36%) and adult (25%) patients, but median PFS was significantly superior in the pediatric cohort (7.4 months vs. 2.2 months).
Conclusions:
- Irinotecan and temozolomide (IT) chemotherapy demonstrates activity in relapsed Ewing sarcoma (ES) across both pediatric and adult populations.
- IT exhibits a favorable toxicity profile with comparable objective response rates in pediatric and adult patients.
- The superior progression-free survival (PFS) observed in the pediatric cohort warrants further investigation in larger studies.
Background:
Irinotecan and temozolomide (IT) is a widely used regimen for relapsed Ewing sarcoma (ES), although studies are largely limited to paediatric populations.
Methods:
We retrospectively reviewed paediatric (< 18 years) and adult patients (≥ 18 years) treated with salvage IT at two institutions. Haematologic toxicities were graded according to common terminology criteria of adverse events. Survival was estimated by the Kaplan-Meier method and compared by the Log Rank test.
Results:
Fifty-three patients were treated with IT from Jan, 2010 to Dec, 2018 (n = 16 paediatric; n = 37 adult). IT was given as second-line (n = 34; 64%) or ≥ third-line (n = 19; 36%). There was no difference in ≥ grade 3/4 haematologic toxicity between paediatrics and adults (31% vs. 35% respectively; p = 0.76). The frequency of diarrhoea of any grade was similar (38% in each group). Of 43 patients assessable for response, 12 (28%) had objective response (1 CR, 11 PR), 12 (28%) stable disease and 19 (44%) disease progression. Objective response rate did not differ between the two groups (36% in paediatrics vs. 25% in adults; p = 0.47). Median PFS was superior in paediatrics vs. adults (7.4 vs. 2.2 months, p = 0.039).
Conclusion:
Irinotecan and temozolomide (IT) chemotherapy has activity for relapsed ES, with favourable toxicity and equally observed objective responses in the paediatric and adult populations. The observed superior PFS for the paediatric cohort requires further confirmation in future studies.
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