Results of Vincristine, Cyclophosphamide and Topotecan Protocol in Refractory/Relapsed Pediatric Solid Tumors: A Single-center Experience

Aim: Despite dramatic progress in the treatment of pediatric solid tumors in the last 3 decades, confronting a relapsed or refractory patient is still challenging. We report our experience of refractory/relapsed pediatric solid tumor patients treated with vincristin + topotecan + cyclophosphamide (VTC) as a salvage therapy. Materials and Methods: Eleven refractory/relapsed patients (5 neuroblastoma, 4 Ewing's sarcoma, 1 rhabdomyosarcoma and 1 osteosarcoma) who were given VTC as a salvage therapy were evaluated. All of them were metastatic at diagnosis and received appropriate initial chemotherapy. VTC consisted of vincristin (1.5 mg/m(2) on day 1), cyclophosphamide (600 mg/m(2)/day with mesna, on days 1 and 2) and topotecan (1 mg/m(2)/day on days 1, 2 and 3). Results: Eleven patients received a total of 53 courses of VTC with a median of 4 (range: 2-14). Median age at diagnosis was 12 years. One patient achieved complete response, 6 patients had stable disease, and 4 patients had progressive disease after 2 courses of VTC. The median survival duration was 28 months after diagnosis while it was 16 months after relapse. The median survival duration after first VTC was 5 months (2-21 months). Myelosuppression was the primary dose limiting toxicity. Conclusion: We concluded that VTC has a clinically tolerable but non-satisfactory effect on relapsed/refractory solid tumors in children.