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Less Intense Treatment for Advanced Neuroblastoma Achieves High Survival Rates

June 2, 2007

Lower doses of chemotherapy yield survival rates higher than 90% for infants and children with stage III or IV neuroblastoma, a new study finds. Neuroblastoma is a cancer that forms in the nerve tissues in the neck, chest, abdomen, pelvis, or adrenal gland in infants and young children. Although survival rates are generally high with the current standard treatment, the treatment can have long-term side effects, such as heart and kidney damage and hearing loss.

This phase III clinical trial was conducted by the Children’s Oncology Group, a cooperative organization of doctors and institutions in the United States, Canada, Australia, and New Zealand, and the study included 362 infants with stage III or IV cancer and 105 children older than 12 months with stage III cancer. Although this study did not directly compare the new, less intensive treatment with the standard, more intensive treatment, the objective was to determine if the overall survival rate of 90% or greater that is typically seen in this group of patients could be achieved with much lower doses of chemotherapy.

In this study, the infants and children received fewer rounds of chemotherapy over a shorter length of total treatment time (10 to 18 individual days of treatment over 84 to 168 days) than the current standard treatment (71 days of treatment over 286 days). Four of the most effective drugs for treating neuroblastoma were used, and researchers consistently substituted cisplatin (Platinol), a drug typically used for treating this cancer, with carboplatin (Paraplatin) because cisplatin has been associated with high rates of long-term side effects, especially hearing loss.

After three years, 96% of the study participants were alive, a rate equivalent to or better than that seen in large clinical trials of the standard (higher dose) treatment. Side effects to the heart, kidney, and liver and hearing loss were all less than 2%, which was much less than infants and children typically experience with the higher-dose treatment.

“This is an important treatment advance. It appears to accomplish similarly high survival rates seen with other, more intensive treatments, and it will be much easier on patients,” said David Baker, MBBS, Director of the Pediatric and Adolescent Hematology-Oncology Program at Princess Margaret Hospital in Perth, Australia, and the study’s lead author. “We continually try to cure as many children as possible while reducing the burden of undergoing treatment and leaving them with as few long-term side effects as possible. This study goes a long way toward meeting that goal.”

What This Means for Patients

Less intense chemotherapy that is still effective for treating neuroblastoma should help minimize the short-term and long-term effects of cancer treatment. The lower-dose chemotherapy will likely become part of the usual treatment for these patients.

American Society for Clinical Oncology Press Release, Annual Meeting 2007

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