Retrospective analysis of combination carboplatin and vinblastine for pediatric low-grade glioma

• DOI: 10.1007/s11060-020-03549-x
• Publication Date: 2020-06-06T09:03:16Z
• Authors: Anandani Nellan; Erin Wright; Kristen Campbell; Kurtis D. Davies; Andrew M. Donson; Vladimir Amani; Alexis Judd; Molly S. Hemenway; Jennifer Raybin; Nicholas K. Foreman; Sarah Rush; Kathleen Dorris
• Keywords: Male; Adolescent; Brain Neoplasms; Infant, Newborn; Infant; Glioma; Vinblastine; Carboplatin; 3. Good health; Survival Rate; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Antineoplastic Combined Chemotherapy Protocols; Humans; Female; Neoplasm Grading; Child; Follow-Up Studies; Retrospective Studies

Low-grade glioma (LGG) represent the most common pediatric central nervous system tumor. When total surgical resection is not feasible, chemotherapy is first-line therapy in children. Multiple pediatric LGG chemotherapy regimens have been investigated with variable 2-year event free survival (EFS) rates of 39-69%. To date, treatment of pediatric LGG with a carboplatin and vinblastine (C/VBL) chemotherapy regimen has only been evaluated in a phase 1 dose-finding study.A retrospective review of pediatric patients with LGG who were treated with C/VBL at Children's Hospital of Colorado or Akron Children's Hospital from 2011 to 2017 was conducted. Data collected included patient demographics, tumor location, disease response, neurofibromatosis 1 (NF1) status, therapy duration and toxicities. Response to therapy was determined by objective findings on imaging and treating physicians' evaluation.Forty-six patients were identified for analysis, all of whom were chemotherapy-naive. Only five patients treated in this cohort had NF1. BRAF fusion was identified in 65% (22/34) of tested tumors. Best therapy response was partial response in nine patients and stable disease in twenty-five patients. Twelve patients had progressive disease. One-year, 3-year, and 5-year EFS probabilities for all patients were 69.6%, 39.4%, and 34.5%, respectively. Nine patients had admissions for febrile neutropenia and seven patients experienced one delay in chemotherapy due to neutropenia. Only two patients had to discontinue this chemotherapy regimen because of treatment-related toxicities [carboplatin allergy (n = 1) and vinblastine neuropathy (n = 1)].C/VBL achieves similar EFS rates to other single-agent and combination cytotoxic chemotherapy regimens for pediatric LGG with manageable toxicities.