Vinorelbine in progressive unresectable low-grade glioma in children.

Abstract

9524 Background: Low grade glioma represent 30-40% off all childhood brain tumors. Optimal treatment when feasible is surgical resection resulting in cure in the majority of the cases. However, the management of progressive unresectable low-grade glioma (PULGG) remains controversial. There is increasing evidence that chemotherapy can delay or even allow avoidance of radiotherapy and/or surgery in these unresectable tumors. Several protocols have been described. However, short and long term toxicity remains a major issue in this chronic disease. Within this context, we present our experience with single agent vinorelbine, a semi-synthetic vinca alkaloid. Methods:From July 2007 to January 2011, 32 patients with recurrent (10) or newly diagnosed (22) PULGG started treatment with vinorelbine 30 mg/m² on days 0, 8 and 22 for a total of 18 cycles. Tumor site was hypothalamic/chiasmatic (19), spinal cord (1), cortex (1), cerebellum (1), brainstem (4), multifocal (3) and 2 patients had gliomatosis. Four children had neurofibromatosis and 3 diencephalic syndrome. Twenty- two patients had prior neurosurgical intervention. Response criteria were based on magnetic resonance imaging and physical examination. Results: Twenty- eight patients (median age 7 years 1 month) were evaluable after 4 cycles of vinorelbine, with objective response (OR) in 9 patients, stable disease (SD) in 19. After 8 cycles, 25 patients were evaluable with 9 OR, 15 SD and 1 PD. After 18 cycles, 18 patients were evaluable for response, 5 with OR, 10 SD and 3 PD. Three patients died: one of disease progression, one of atypical pneumonia and one of tracheotomy obstruction. Toxicity was mild and manageable in most cases: Grade I/II gastrointestinal toxicity was observed in 9 patients, grade I/II neurotoxicity in 2 patients and grade IV hematologic toxicity in 3 patients. Conclusions: Our preliminary results suggest that vinorelbine is active in patients with ULGG. This drug offers several advantages including a low toxicity profile associated with excellent quality of life.