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Response of untreated stage IV Wilms' tumor to single dose carboplatin assessed by "up front" window therapy
A Zoubek1, P Kajtar, B Flucher-Wolfram
1St. Anna Children's Hospital, Austria.
Insights
A single dose of carboplatin showed encouraging response rates in children with stage IV Wilms' tumor. This upfront window therapy demonstrated acceptable toxicity, suggesting carboplatin
Area of Science:
- Pediatric Oncology
- Medical Chemotherapy
- Nephroblastoma Research
Background:
- Wilms' tumor is a common pediatric kidney cancer.
- Stage IV Wilms' tumor has a poorer prognosis.
- Effective neoadjuvant therapies are crucial for improving outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a single preoperative dose of carboplatin in children with stage IV Wilms' tumor.
- To assess tumor response and side effects of upfront carboplatin therapy.
- To determine carboplatin's potential role as an initial treatment in favorable histology Wilms' tumor.
Main Methods:
- Nine children with untreated stage IV Wilms' tumor received a single dose of carboplatin (600 mg/m2).
- Response was evaluated using chest X-ray, CT scans, and sonography on day 22.
- Side effects were monitored using WHO criteria.
Main Results:
- A 78% partial response rate was observed in abdominal tumors, with a median 62% volume reduction.
- Metastasis response included four complete and four partial remissions.
- The main side effects were thrombocytopenia and leukocytopenia; no renal or liver toxicity occurred.
Conclusions:
- Preoperative single-dose carboplatin demonstrates encouraging efficacy in stage IV Wilms' tumor.
- The observed toxicity profile is acceptable, with no significant organ damage.
- Carboplatin is a potentially effective addition to the treatment of previously untreated Wilms' tumor.
Abstract:
A total of nine children with previously untreated stage IV Wilms' tumor of favorable histology were treated according to the Austrian/Hungarian Wilms' Tumor Protocol 89 and received a preoperative single dose of carboplatin as an "up front" window therapy. The treatment consisted of carboplatin as a single-dose of 600 mg/m2 over 30 minutes on day 1. Response evaluation by chest X-ray, serial CT scans, and sonography was performed on day 22. Investigation of the abdominal tumors revealed seven partial responses (78%), one nonresponse, and one progressive disease with a median tumor volume reduction of 62%. Response of metastases evaluated by CT scans was as follows: four complete remission, four partial response, and one nonresponse. Thrombocytopenia (WHO grade III 1, grade II 2, grade I 2) and leukocytopenia (WHO grade II 1, grade I 5) were the main side effects. No renal or liver toxicity were observed. The overall response rate after a preoperative single-dose of 600 mg/m2 carboplatin in untreated patients with stage IV Wilms' tumor is encouraging and the toxicity acceptable. This data indicate that carboplatin seems to be an additional effective drug in patients with previously untreated Wilms' tumor of favorable histology.