A modified chemotherapy protocol with carboplatin and vincristine for pediatric brain stem low-grade gliomas

Abstract

Objective To analyze the response and toxicity of a modified chemotherapy protocol with carboplatin and vincristine (CV) for pediatric low-grade gliomas (LGGs) in the brain stem. Methods Ten children with low-grade gliomas (LGGs) in the brain stem were administered the modified CV regimen at Department of Neuro-Oncology, Sanbo Brain Hospital, Capital Medical University from August 2014 to August 2016, and the data were retrospectively reviewed. The conventional CV regimen was modified by changing the carboplatin dose or adding recombinant human endostatin(rhES). Carboplatin was administrated at a dose of 200~300 mg/m2 and the vincristine dose was 1.5 mg/m2 (maximum dose: 2 mg). Results Among the 10 children, 5 patients had objective response (1 had a complete response and 4 had a partial response); 2 got a minor response and 3 kept stable conditions. All patients' illnesses were effectively controlled. The median time for response to chemotherapy was 3 (1.5-8.0) months.The median time for follow-up was 14.5(4-26)months. Objective response was reported in 2 of 3 patients with recurrence. All 3 cases undergoing combination chemotherapy of carboplatin, vincristine and a novel antiangiogenic drug had objective response. Hematologic toxicity was a major side effect. The incidences of severe neutrocytopenia, decreased hemoglobin and thrombocytopenia were 8.8% (23/262), 5.3% (14/262) and 1.5% (5/262), respectively, which could resolve following symptomatic treatment. Conclusions A modified CV regimen seems effective for pediatric brain stem LGGs. Increasing carboplatin dose or adding rhES could help with the effect improvement of CV regimen and fast relief of the brain stem dysfunction. Those drug regimens were relatively well tolerated. Key words: Brain stem neoplasms; Glioma; Carboplatin; Vincristine; Child