D-CECAT - A BREAKTHROUGH FOR PATIENTS WITH NEUROBLASTOMA

In view of the high relapse rate following chemotherapy for patients w ith advanced neuroblastoma (NB) and primitive neuroectodermal tumors ( PNET), we designed a novel chemotherapy program which incorporated the iron chelator deferoxamine. The purpose of the deferoxamine was to se nsitize the cells to standard chemotherapy. The D-CECaT regimen contai ned (in mg/m2): deferoxamine 4500 during days 1-5; cyclophosphamide 60 0 mg over days 6 and 7; etoposide 300 mg over days 7 and 8; carboplati n 100 mg over days 7 and 8; and thiotepa 30 mg over days 6-8. Between October 1989 and May 1992 we entered 23 advanced NB and two PNET patie nts. Sepsis occurred in four courses, nausea and vomiting in 30 course s, and 50 courses required blood and platelets. Responses observed in previously untreated patients with stage III NB: six out of six CR (17 + to 41 + months), with stage IV NB, nine out of 11 CR (1 4 + to 28 months), two out of 11 VGPR (22 + months), with stage IV PNET two out of two CR (1 + to 35 + months). With previously treated and failed st age IV NG, two out of six VGPR for 19 + and 20 months, and four out of six PR 1, 8, 9 and 11 months. Median survival for 19 new patients was 22 + months (6 to 41 + months; two patients in CR died at 7 months du ring adjuvant autologous marrow transplant). In conclusion, D-CECaT is an effective initial cytoreductive regimen for advanced stage NB/PNET patients. Additional patients and studies are required to determine i ts use as an alternative to autologous bone marrow transplantation.