CHRONIC ORAL VP-16 FOR RECURRENT MEDULLOBLASTOMA

Chronic oral VP-16 (Etoposide) is a chemotherapy regimen with wide app lication in oncology and documented efficacy against germ cell tumors, lymphomas, Kaposi sarcoma, and glial brain tumors, Eight patients ran ging in age from 4 to 36 years (median 7.5 years) with locally recurre nt medulloblastoma were treated with VP-16, No patient displayed evide nce of cerebrospinal fluid dissemination, distant brain or spine paren chymal metastases, or extraneural metastatic disease, All patients had previously been treated with surgery (gross total resection, 5; subto tal resection, 3), craniospinal radiotherapy, and platinum-based chemo therapy (adjuvant, 3; salvage, 8), Each cycle of therapy consisted of 21 days of VP-16 (50 mg/m(2)/day) followed by a 7 to 14 day rest follo wed by an additional 21 days of VP-16 (50 mg/m(2)/day), Complete blood counts were obtained weekly, Neurologic examination and brain magneti c resonance imaging scan with contrast were performed prior to each cy cle of therapy, Treatment-related complications included: partial alop ecia (5 patients); diarrhea (4); weight loss (3); anemia (2); neutrope nia (4); and thrombocytopenia (4), Two patients required transfusion a nd 1 patient received antibiotics for neutropenic fever, All patients were evaluable for response: 3 demonstrated progressive disease after the first cycle of VP-16, 3 had stable disease (range 4 to 6 months) a nd 2 had partial neuroradiographic responses (8 and 10 months), Median duration of response and stable disease was 6 months (range: 4 to 10 months) in 5 of 8 (62.5%) patients, Chronic oral VP-16 is a well-toler ated and relatively non-toxic chemotherapeutic agent with demonstrated activity in locally recurrent medulloblastoma. (C) 1997 by Elsevier S cience Inc. All rights reserved.