Induction Regimens in High-Risk Neuroblastoma: Systematic Review of Response Rates and Toxicities

Area of Science:

• Pediatric Oncology
• Clinical Trial Analysis
• Cancer Therapeutics

Background:

• High-risk neuroblastoma (HRNBL) treatment involves various induction therapies.
• Comparative data on response rates and toxicities of HRNBL induction regimens are lacking.

Purpose of the Study:

• To describe and compare key features of HRNBL induction regimens.
• To assess associations between regimen characteristics and end-induction response (EIR).

Main Methods:

• Systematic review of prospective frontline HRNBL therapy trials (PubMed, 1995-2024).
• Included studies reporting end-induction response (EIR) as partial response or better (PR+).
• Analyzed regimen details including agents, doses, duration, and patient numbers.

Main Results:

• 29 publications evaluated 36 HRNBL induction regimens.
• Median study-level EIR rate was 84.4% (weighted average 79.4%), with no improvement over time.
• Anthracycline-containing regimens showed higher EIRs; higher cisplatin dose intensity was linked to lower EIR.
• Only 16.7% of regimens included novel agents; toxic death rate was 0% median.

Conclusions:

• HRNBL induction therapies have predominantly used conventional chemotherapy for 30 years.
• Despite variations in treatment, study-level EIR rates have remained stagnant.
• Incorporating novel agents into future induction regimens is essential for improving EIR and reducing toxicity.