Intensified platinum therapy is an ineffective strategy for improving outcome in pediatric patients with advanced hepatoblastoma

Marcio Malogolowkin, Howard Katzenstein, Mark D. Krailo, Zhengjia Chen, Laura Bowman, Marleta Reynolds, Milton Finegold, Brian Greffe, Jon Rowland, Kurt Newman, Richard B. Womer, Wendy B. London, Robert P. Castleberry

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Purpose: The INT-0098 Intergroup Liver Tumor Study demonstrated no statistically significant differences in event-free and overall survival between patients randomized to treatment with either cisplatin + fluorouracil + vincristine (C5V) or cisplatin + doxorubicin. Results from this and other therapeutic trials suggested that cisplatin was the most active agent against hepatoblastoma. To increase the platinum dose-intensity, a novel regimen was developed alternating carboplatin and cisplatin (CC) every 2 weeks. The P9645 study was designed to compare the risk of treatment failure for patients with stage III/IV hepatoblastoma randomized to either C5V or CC. Methods: C5V was given according to INT-0098 and CC consisted of carboplatin at 700 mg/m 2 on day 0 (560 mg/m2 after two cycles) followed by cisplatin 100 mg/m2 on day 14. Granulocyte colony-stimulating factor was used after each CC cycle. All patients received four to six cycles of chemotherapy. Results: From the time the study was opened until the time that random assignment was halted, 56 patients received CC and 53 patients received C5V. The 1-year event-free survival was 37% for patients receiving CC and 57% for those receiving C5V (P = .017). Patients randomly assigned to CC required more blood product support. As a result of a semiannual review by the Children's Oncology Group Data and Safety Monitoring Committee, random assignment was discontinued after 3 years of enrollment because the projected improvement in long-term outcome associated with CC was statistically excluded as a possible outcome of this trial. Conclusion: Intensification of therapy by alternating platinum analogs increased the risk of adverse outcome in children with unresectable or metastatic hepatoblastoma.

Original languageEnglish (US)
Pages (from-to)2879-2884
Number of pages6
JournalJournal of Clinical Oncology
Volume24
Issue number18
DOIs
StatePublished - Jun 20 2006
Externally publishedYes

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Hepatoblastoma
Platinum
Cisplatin
Carboplatin
Pediatrics
Therapeutics
Disease-Free Survival
Clinical Trials Data Monitoring Committees
Time and Motion Studies
Vincristine
Granulocyte Colony-Stimulating Factor
Treatment Failure
Fluorouracil
Doxorubicin

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Intensified platinum therapy is an ineffective strategy for improving outcome in pediatric patients with advanced hepatoblastoma. / Malogolowkin, Marcio; Katzenstein, Howard; Krailo, Mark D.; Chen, Zhengjia; Bowman, Laura; Reynolds, Marleta; Finegold, Milton; Greffe, Brian; Rowland, Jon; Newman, Kurt; Womer, Richard B.; London, Wendy B.; Castleberry, Robert P.

In: Journal of Clinical Oncology, Vol. 24, No. 18, 20.06.2006, p. 2879-2884.

Research output: Contribution to journalArticle

Malogolowkin, M, Katzenstein, H, Krailo, MD, Chen, Z, Bowman, L, Reynolds, M, Finegold, M, Greffe, B, Rowland, J, Newman, K, Womer, RB, London, WB & Castleberry, RP 2006, 'Intensified platinum therapy is an ineffective strategy for improving outcome in pediatric patients with advanced hepatoblastoma', Journal of Clinical Oncology, vol. 24, no. 18, pp. 2879-2884. https://doi.org/10.1200/JCO.2005.02.6013
Malogolowkin, Marcio ; Katzenstein, Howard ; Krailo, Mark D. ; Chen, Zhengjia ; Bowman, Laura ; Reynolds, Marleta ; Finegold, Milton ; Greffe, Brian ; Rowland, Jon ; Newman, Kurt ; Womer, Richard B. ; London, Wendy B. ; Castleberry, Robert P. / Intensified platinum therapy is an ineffective strategy for improving outcome in pediatric patients with advanced hepatoblastoma. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 18. pp. 2879-2884.
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abstract = "Purpose: The INT-0098 Intergroup Liver Tumor Study demonstrated no statistically significant differences in event-free and overall survival between patients randomized to treatment with either cisplatin + fluorouracil + vincristine (C5V) or cisplatin + doxorubicin. Results from this and other therapeutic trials suggested that cisplatin was the most active agent against hepatoblastoma. To increase the platinum dose-intensity, a novel regimen was developed alternating carboplatin and cisplatin (CC) every 2 weeks. The P9645 study was designed to compare the risk of treatment failure for patients with stage III/IV hepatoblastoma randomized to either C5V or CC. Methods: C5V was given according to INT-0098 and CC consisted of carboplatin at 700 mg/m 2 on day 0 (560 mg/m2 after two cycles) followed by cisplatin 100 mg/m2 on day 14. Granulocyte colony-stimulating factor was used after each CC cycle. All patients received four to six cycles of chemotherapy. Results: From the time the study was opened until the time that random assignment was halted, 56 patients received CC and 53 patients received C5V. The 1-year event-free survival was 37{\%} for patients receiving CC and 57{\%} for those receiving C5V (P = .017). Patients randomly assigned to CC required more blood product support. As a result of a semiannual review by the Children's Oncology Group Data and Safety Monitoring Committee, random assignment was discontinued after 3 years of enrollment because the projected improvement in long-term outcome associated with CC was statistically excluded as a possible outcome of this trial. Conclusion: Intensification of therapy by alternating platinum analogs increased the risk of adverse outcome in children with unresectable or metastatic hepatoblastoma.",
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AU - Malogolowkin, Marcio

AU - Katzenstein, Howard

AU - Krailo, Mark D.

AU - Chen, Zhengjia

AU - Bowman, Laura

AU - Reynolds, Marleta

AU - Finegold, Milton

AU - Greffe, Brian

AU - Rowland, Jon

AU - Newman, Kurt

AU - Womer, Richard B.

AU - London, Wendy B.

AU - Castleberry, Robert P.

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N2 - Purpose: The INT-0098 Intergroup Liver Tumor Study demonstrated no statistically significant differences in event-free and overall survival between patients randomized to treatment with either cisplatin + fluorouracil + vincristine (C5V) or cisplatin + doxorubicin. Results from this and other therapeutic trials suggested that cisplatin was the most active agent against hepatoblastoma. To increase the platinum dose-intensity, a novel regimen was developed alternating carboplatin and cisplatin (CC) every 2 weeks. The P9645 study was designed to compare the risk of treatment failure for patients with stage III/IV hepatoblastoma randomized to either C5V or CC. Methods: C5V was given according to INT-0098 and CC consisted of carboplatin at 700 mg/m 2 on day 0 (560 mg/m2 after two cycles) followed by cisplatin 100 mg/m2 on day 14. Granulocyte colony-stimulating factor was used after each CC cycle. All patients received four to six cycles of chemotherapy. Results: From the time the study was opened until the time that random assignment was halted, 56 patients received CC and 53 patients received C5V. The 1-year event-free survival was 37% for patients receiving CC and 57% for those receiving C5V (P = .017). Patients randomly assigned to CC required more blood product support. As a result of a semiannual review by the Children's Oncology Group Data and Safety Monitoring Committee, random assignment was discontinued after 3 years of enrollment because the projected improvement in long-term outcome associated with CC was statistically excluded as a possible outcome of this trial. Conclusion: Intensification of therapy by alternating platinum analogs increased the risk of adverse outcome in children with unresectable or metastatic hepatoblastoma.

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