VIP (etoposide, ifosfamide, cisplatin) in adult patients with recurrent or refractory Ewing sarcoma family of tumors
VIP (etoposide, ifosfamide, cisplatin) in adult patients with recurrent or refractory Ewing sarcoma family of tumors
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DOI：
10.1097/01.coc.0000135815.94162.83
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发表时间：
2004-10-01
影响因子：
2.6
通讯作者：
Ezzat, A
中科院分区：
文献类型：
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作者：
El Weshi, A;Memon, M;Ezzat, A
尽管尤文肉瘤家族肿瘤（ET）对化疗敏感，但长期存活的患者非常罕见，或者是原发性难治性或复发性疾病。在这种情况下，没有标准的补救化疗方案。在这项研究中，作者回顾了他们在复发性或难治性疾病成人患者中使用依托泊苷、异环磷酰胺和顺铂联合治疗的经验。从1997年2月至2001年12月，他们评价了依托泊苷（75 mg/m2/天，持续5天）、异环磷酰胺（1,200 mg/m2/天，持续5天）和顺铂（20 mg/m2/天，持续5天）联合化疗（VIP方案）作为27例复发性或难治性ET患者的二线挽救治疗的疗效。对所有患者的反应、进展时间和总生存期进行评价。21例男性和6例女性复发性（n = 14）和难治性（n = 13）疾病患者接受VIP方案治疗。年龄中位数为18岁（范围... 16-34岁）。22例患者既往接受过长春新碱、阿霉素、异环磷酰胺和放线菌素D治疗; 5例患者接受过环磷酰胺、阿霉素和长春新碱治疗。复发或进展性疾病的部位包括局部（n = 3）。远处（n = 11），以及局部和远处（n = 13）。共给予129个周期的VIP（中位数，5个周期/患者;范围，1-14个周期/患者）。1例患者（4%）完全缓解（CR），8例患者（30%）部分缓解（PR），总缓解率为34%。CR + PR患者接受的中位周期数为6个（范围：3-14个周期）。9例患者（33%）病情稳定，9例患者（33%）病情进展。所有患者的中位进展时间和中位总生存期分别为6.6个月和8.1个月，应答者分别为12.8个月和14.2个月。没有中毒死亡。主要毒性包括19例患者的IV级粒细胞减少和15例患者的III/IV级血小板减少。在中位随访8个月（范围，2-56个月）时，24例患者死于疾病进展，2例患者存活，1例患者存活，无疾病证据。作者得出结论，VIP联合治疗对复发性/难治性ET患者有效，毒性可接受，并提供了良好的缓解。顺铂为基础的联合化疗值得进一步研究，可能作为一线治疗这种疾病。
Despite the fact that Ewing sarcoma family of tumors (ET) is chemosensitive, long-term survival is extremely rare or patients with primary refractory or recurrent disease. There is no standard salvage chemotherapy regimen available in this context. In this study the authors reviewed their experience with the combination of etoposide, ifosfamide, and cisplatin in adult patients with recurrent or refractory disease. From February 1997 through December 2001, they evaluated the efficacy of etoposide (75 mg/m(2)/day for 5 days), ifosfamide (1,200 mg/m(2)/day for 5 days), and cisplatin (20 mg mg/m(2)/day for 5 days) combination chemotherapy (VIP regimen), as second-line salvage therapy in 27 patients with recurrent or refractory ET. All patients were evaluated for response, time to progression, and overall survival. Twenty-one male and 6 female patients with recurrent (n 14) and refractory (n = 13) disease were treated with the VIP regimen. Median age was 18 years (range.. 16-34 years). Twenty-two patients were previously treated with vincristine, Adriamycin, ifosfamide, and actinomycin-D; and 5 patients were treated with cyclophosphamide, Adriamycin, and vincristine. Sites of recurrent or progressive disease included local (n = 3),. distant (n = 11), and both local and distant (n = 13). A total of 129 cycles of VIP were given (median, 5 cycles/patient; range, 1-14 cycles/patient). One patient (4%) had a complete response (CR) and 8 patients (30%) had a partial response (PR), for an overall response rate of 34%. The median number of cycles given to patients with CR + PR was 6 (range, 3-14 cycles). Nine patients (33%) had stable disease and 9 (33%) had disease progression. Median time to progression and median overall survival were 6.6 months and 8.1 months respectively for all patients, and 12.8 months and 14.2 months respectively for responders. There were no toxic deaths. Major toxicities included grade IV granulocytopenia in 19 patients and grades III/IV thrombocytopenia in 15 patients. At a median follow-up of 8 months (range, 2-56 months), 24 patients died of disease progression, 2 patients are alive with disease, and I patient is alive with no evidence of disease. The authors conclude that the VIP combination is active in patients with recurrent/refractory ET, with acceptable toxicity, and offers good palliation. Cisplatin-based combination chemotherapy merits further investigation, possibly as first-line treatment in this disease.