ATRT; angiogenesis; brain tumors; immunotherapy; medulloblastoma; metronomic chemotherapy; pediatric oncology; pharmacology; Medicine (all); General Medicine
Abstract :
[en] BACKGROUND: Relapses in pediatric high-risk brain tumors remain unmet medical needs. Over the last 15 years, metronomic chemotherapy has gradually emerged as an alternative therapeutic approach.
PATIENTS AND METHODS: This is a national retrospective study of patients with relapsing pediatric brain tumors treated according to the MEMMAT or MEMMAT-like regimen from 2010 to 2022. Treatment consisted of daily oral thalidomide, fenofibrate, and celecoxib, and alternating 21-day cycles of metronomic etoposide and cyclophosphamide associated with bevacizumab and intraventricular chemotherapy.
RESULTS: Forty-one patients were included. The most frequent malignancies were medulloblastoma (22) and ATRT (8). Overall, the best responses were CR in eight patients (20%), PR in three patients (7%), and SD in three patients (7%), for a clinical benefit rate of 34%. The median overall survival was 26 months (IC95% = 12.4-42.7), and median EFS was 9.7 months (IC95% = 6.0-18.6). The most frequent grade ¾ toxicities were hematological. Dose had to be adjusted in 27% of the cases. There was no statistical difference in outcome between full or modified MEMMAT. The best setting seems to be when MEMMAT is used as a maintenance and at first relapse.
CONCLUSIONS: The metronomic MEMMAT combination can lead to sustained control of relapsed high-risk pediatric brain tumors.
Disciplines :
Oncology
Author, co-author :
Winnicki, Camille; Department of Pediatric Immunology, Hematology and Oncology, Children Hospital of La Timone, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
Leblond, Pierre ; Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, 69008 Lyon, France
Bourdeaut, Franck; SIREDO Pediatric Oncology Center, Curie Institute, 75005 Paris, France
Pagnier, Anne; Department of Pediatric Immunohematology and Oncology, University Hospital, 38043 Grenoble, France
Paluenzela, Gilles; Department of Pediatric Hematology-Oncology, Centre Hospitalo-Universitaire de Montpellier, 34000 Montpellier, France
Chastagner, Pascal; Pediatric Oncology, University Hospital of Nancy, 54000 Nancy, France
Duhil-De Benaze, Gwenaelle; Department of Pediatric Oncology, Centre Hospitalier Universitaire, University Côte d'Azur, 06108 Nice, France
Min, Victoria; Department of Pediatric Immunology, Hematology and Oncology, Children Hospital of La Timone, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
Sudour-Bonnange, Hélène; Oscar-Lambret Center, Department of Pediatric Oncology & AYA Unit, 59020 Lille, France
Piette, Caroline ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pédiatrie
Entz-Werle, Natacha ; Pediatric Onco-Hematology Department-Pediatrics III, University Hospital of Strasbourg, 67091 Strasbourg, France
Chabaud, Sylvie ; Department of Statistics, Centre Léon Bérard, 69373 Lyon, France
André, Nicolas ; Department of Pediatric Immunology, Hematology and Oncology, Children Hospital of La Timone, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France ; Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, Inserm, CNRS, 13273 Marseille, France ; Metronomics Global Health Initiative, 13385 Marseille, France
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