ESCALATING DOSE OF CONTINUOUS INFUSION COMBINATION CHEMOTHERAPY FOR REFRACTORY NEUROBLASTOMA

Purpose: This trial was undertaken to determine if a continuous infusion format with increased dose-intensity had antitumor activity with tolerable toxicity in patients with advanced neuroblastoma. Patients and Methods; Forty heavily pretreated patients with refractory or progressive neuroblastoma received continuous infusion doxorubicin, cisplatin, and etoposide along with bolus ifosfamide in a dose-escalation format. A total of 79 courses of chemotherapy were administered at five different dose levels. Results: Fifteen of 35 assessable patients (43%) achieved either a partial response (PR) or complete re-sponse (CR), including five patients with a CR, three with a very good PR (VGPR), and seven with a PR. Hematologic toxicity was severe, but reversible, and other toxicities, although significant, were tolerable and much less than that accepted in a bone marrow transplantation (BMT) setting. Conclusion: This investigation illustrates that response is possible even in an extremely poor-prognosis group of patients, and it suggests that such a regimen may be effective if given before disease progression occurs. © 1993 by American Society of Clinical Oncology.