A. Zoubek et al., HIGH-DOSE CYCLOPHOSPHAMIDE, ADRIAMYCIN, AND VINCRISTINE (HD-CAV) IN CHILDREN WITH RECURRENT SOLID TUMOR, Pediatric hematology and oncology, 11(6), 1994, pp. 613-623
A dose-intensive regimen of cyclophosphamide (140 mg/kg over 2 days),
doxorubicin (Adriamycin, 75 mg/m(2) over 3 days), and vincristine (1 m
g/m(2) on days 1, 2, and 3 and 1.5 mg/m(2) on day 9) war tested in 18
children and adolescents with poor-prognosis recurrent: or refractory
solid tumors. Nine were affected by neuroblastoma, 3 by Ewing's tumors
, 2 by rhabdomyosarcoma, 2 by synovial sarcoma, 1 by hepatocellular ca
rcinoma, and 1 by osteogenic sarcoma. All enrolled patients were heavi
ly pretreated, including 2 patients after bone marrow transplantation.
Forty courses were applied (median, 2). The overall response rate was
33% (2 complete remissions and 4 partial remissions). Responses were
obtained in children with neuroblastoma, Ewing's tumors, and hepatocel
lular carcinoma. Myelosuppression [World Health Organization (WHO) gra
de IV after all courses] and cardiac toxicity (3 WHO grade I, 5 WHO gr
ade III, and 3 WHO grade IV) were the main side effects. Nephrotoxicit
y and hepatoxicity were not observed. With further therapy consisting
of surgery, radiotherapy, and high-dose chemotherapy [cisplatin, carbo
platin/etoposide (VP16), or ifosfamide/VP16 with or without autologous
stem cell reinfusion after conditioning with melphalan/VP16/carboplat
in], 3 complete remissions and 5 very good partial remissions were obt
ained. Ten of 18 patients are alive after a median follow-up of 16 mon
ths.