1. Extended induction chemotherapy does not improve the outcome for high-risk neuroblastoma patients: results of the randomized open-label GPOH trial NB2004-HR
- Author
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Christian P. Kratz, D. von Schweinitz, Michael C. Frühwald, T. Klingebiel, D. Dilloo, Andreas Faldum, Frank Berthold, Ruth Volland, Angelika Eggert, Thorsten Simon, Roswitha Schumacher-Kuckelkorn, Bernhard Kremens, Ivo Leuschner, Matthias Fischer, Angela Ernst, Freimut H. Schilling, Joachim Boos, Barbara Krug, Matthias Schmidt, Barbara Hero, Günter Henze, Rene Schmidt, and Jessica Theissen
- Subjects
0301 basic medicine ,Adult ,medicine.medical_specialty ,Cyclophosphamide ,Adolescent ,medicine.medical_treatment ,Medizin ,Disease-Free Survival ,law.invention ,03 medical and health sciences ,Neuroblastoma ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,Internal medicine ,Germany ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Clinical endpoint ,Humans ,ddc:610 ,Prospective Studies ,Child ,Etoposide ,Chemotherapy ,business.industry ,Induction chemotherapy ,Infant ,Hematology ,Induction Chemotherapy ,030104 developmental biology ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Child, Preschool ,Topotecan ,business ,Switzerland ,medicine.drug - Abstract
Background Long-term survival of high-risk neuroblastoma patients is still below 50% despite intensive multimodal treatment. This trial aimed to address whether the addition of two topotecan-containing chemotherapy courses compared to standard induction therapy improves event-free survival (EFS) of these patients. Patients and methods An open-label, multicenter, prospective randomized controlled trial was carried out at 58 hospitals in Germany and Switzerland. Patients aged 1–21 years with stage 4 neuroblastoma and patients aged 6 months to 21 years with MYCN-amplified tumors were eligible. The primary endpoint was EFS. Patients were randomly assigned to standard induction therapy with six chemotherapy courses or to experimental induction chemotherapy starting with two additional courses of topotecan, cyclophosphamide, and etoposide followed by standard induction chemotherapy (eight courses in total). After induction chemotherapy, all patients received high-dose chemotherapy with autologous hematopoietic stem cell rescue and isotretinoin for consolidation. Radiotherapy was applied to patients with active tumors at the end of induction chemotherapy. Results Of 536 patients enrolled in the trial, 422 were randomly assigned to the control arm (n = 211) and the experimental arm (n = 211); the median follow-up time was 3.32 years (interquartile range 1.65–5.92). At data lock, the 3-year EFS of experimental and control patients was 34% and 32% [95% confidence Interval (CI) 28% to 40% and 26% to 38%; P = 0.258], respectively. Similarly, the 3-year overall survival of the patients did not differ [54% and 48% (95% CI 46% to 62% and 40% to 56%), respectively; P = 0.558]. The response to induction chemotherapy was not different between the arms. The median number of non-fatal toxicities per patient was higher in the experimental group while the median number of toxicities per chemotherapy course was not different. Conclusion While the burden for the patients was increased by prolonging the induction chemotherapy and the toxicity, the addition of two topotecan-containing chemotherapy courses did not improve the EFS of high-risk neuroblastoma patients and thus cannot be recommended. Clinical Trials.gov number NCT number 03042429.
- Published
- 2019