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Comparison of dose intensity of vincristine, d-actinomycin, and cyclophosphamide chemotherapy for child and adult rhabdomyosarcoma: a retrospective analysis

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Abstract

Purpose

The prognosis of adult rhabdomyosarcoma (RMS) has been considered dismal. The question is raised that vincristine, d-actinomycin, and cyclophosphamide (VAC) chemotherapy may not be administered as per schedule for adult RMS; consequently, low dose intensity (DI) leads to poor prognosis. Herein, we examined whether the administration of VAC chemotherapy for adults and children with RMS is feasible with regard to the DIs of VAC.

Methods

Chart review was retrospectively performed for all identified patients. The percentage of relative DI (RDI) was calculated according to the Children’s Oncology Group D9803 protocol. Further, we examined the RDI in the first 6 cycles of VAC (induction phase) and the DI after the first 6 cycles of VAC (maintenance phase).

Results

We identified a total of 27 adults and 18 children with RMS, respectively. The mean RDIs of vincristine in total phase were significantly lower in adults than that in children (P = 0.04). In induction phase, the mean RDIs of vincristine and cyclophosphamide were similar for both groups; however, they were dropped significantly in adults during maintenance phase (P < 0.05). Mean RDIs of vincristine in elderly patients tended to become low. Low RDI was mainly attributable to hematologic toxicity, infection, and peripheral neuropathy. The prognosis of low versus high RDI was similar.

Conclusions

The RDIs of vincristine and cyclophosphamide in the maintenance phase were significantly lower than that in children. VAC chemotherapy for adults was not feasible; these patients require a different regimen.

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Abbreviations

RMS:

Rhabdomyosarcoma

VAC:

Vincristine, d-actinomycin, and cyclophosphamide

DI:

Dose intensity

RDI:

Relative dose intensity

IRS:

The International Rhabdomyosarcoma Study

PFS:

Progression-free survival

OS:

Overall survival

PCP:

Pneumocystis jirovecci pneumonia

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Acknowledgments

We thank all the participants for supporting this study. Mrs. N. Nakamura supported for revising the manuscript.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Medical Oncology and Breast Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yuki Kojima, Kenji Hashimoto, Masashi Ando, Kan Yonemori, Harukaze Yamamoto, Makoto Kodaira, Mayu Yunokawa, Chikako Shimizu, Kenji Tamura & Yasuhiro Fujiwara

  2. Department of Hematology and Medical Oncology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan

    Yuki Kojima

  3. Department of Pediatric Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Ako Hosono & Atsushi Makimoto

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  1. Yuki Kojima
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  2. Kenji Hashimoto
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  3. Masashi Ando
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Correspondence to Kenji Hashimoto.

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Kojima, Y., Hashimoto, K., Ando, M. et al. Comparison of dose intensity of vincristine, d-actinomycin, and cyclophosphamide chemotherapy for child and adult rhabdomyosarcoma: a retrospective analysis. Cancer Chemother Pharmacol 70, 391–397 (2012). https://doi.org/10.1007/s00280-012-1920-0

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  • DOI: https://doi.org/10.1007/s00280-012-1920-0

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