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Article

Oral Metronomic Maintenance Therapy Can Improve Survival in High-Risk Neuroblastoma Patients Not Treated with ASCT or Anti-GD2 Antibodies

by 1,2,*,†, 1,2,†, 1,3, 1,4, 1,2, 1,5, 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, 6, 1,7, 1,8 and 1,9,*
1
State Key Laboratory of Oncology in South China, Guanghzou 510060, China
2
Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
3
Department of Clinical Research, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
4
Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
5
Department of Pathology, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
6
Department of Pediatric Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510060, China
7
Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
8
Department of Radiology, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
9
Department of Urology Surgery, Sun Yat-sen University Cancer Center, Guanghzou 510060, China
*
Authors to whom correspondence should be addressed.
Both are Co-first authors.
Academic Editors: Saurabh Agarwal and Yang Jianhua
Cancers 2021, 13(14), 3494; https://doi.org/10.3390/cancers13143494
Received: 4 June 2021 / Revised: 7 July 2021 / Accepted: 7 July 2021 / Published: 13 July 2021
(This article belongs to the Special Issue Pediatric Cancers)
Low-dose metronomic chemotherapy has anti-angiogenic activity and inhibits tumor growth. Therefore, we investigated the benefits of low-dose metronomic maintenance therapy (MT) in high-risk neuroblastoma (NB) patients who are unable to undergo autologous stem cell transplantation (ASCT) or anti-GD2 antibody therapy. A total of 217 high-risk NB patients were enrolled. One hundred and eighty-five (85%) had a complete/very good partial remission/partial remission (CR/VGPR/PR) to treatment, of them, 167 patients with stage 4, that did or did not receive oral metronomic MT, 3 years of event-free survival (EFS) were 42.5% versus 29.4%, and overall survival (OS) was 71.1% versus 59.4%, respectively. Totally, 117 high-risk patients with oral metronomic MT had an EFS rate of 42.7%. The results were similar to those of ASCT from other studies. The toxicities of metronomic MT were lower. Our study showed that oral metronomic MT is an optimal option for high-risk NB patients without ASCT or anti-GD2 antibody therapy.
Despite aggressive treatment, the prognosis of high-risk NB patients is still poor. This retrospective study investigated the benefits of metronomic maintenance treatment (MT) in high-risk NB patients without ASCT or GD2 antibody therapy. Patients aged ≤ 21 years with newly diagnosed high-risk NB were included. Patients with complete/very good partial remission (CR/VGPR/PR) to conventional treatment received, or not, oral metronomic MT for 1 year. Two hundred and seventeen high-risk NB patients were enrolled. One hundred and eighty-five (85%) had a CR/VGPR/PR to conventional treatment, of the patients with stage 4, 106 receiving and 61 not receiving oral metronomic MT, and the 3-year event-free survival (EFS) rate was 42.5 ± 5.1% and 29.6 ± 6%, respectively (p = 0.017), and overall survival (OS) rate was 71.1 ± 4.7% and 59.4 ± 6.4%, respectively (p = 0.022). A total of 117 high-risk patients with oral metronomic MT had EFS rate of 42.7 ± 4.8%. The toxicity of MT was mild. For high-risk NB patients without ASCT or anti-GD2 antibody therapy, stage 4, MYCN amplication and patients with stage 4 not receiving oral metronomic MT after CR/VGPR/PR were independent adverse prognostic factors. Oral metronomic MT can improve survival in high-risk NB patients in CR/VGPR/PR without ASCT or anti-GD2 antibodies therapy. View Full-Text
Keywords: neuroblastoma; metronomic chemotherapy; maintenance therapy; high-risk neuroblastoma; metronomic chemotherapy; maintenance therapy; high-risk
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Figure 1

MDPI and ACS Style

Sun, X.; Zhen, Z.; Guo, Y.; Gao, Y.; Wang, J.; Zhang, Y.; Zhu, J.; Lu, S.; Sun, F.; Huang, J.; Cai, R.; Zhang, Y.; Liu, J.; Xiao, Z.; Zeng, S.; Liu, Z. Oral Metronomic Maintenance Therapy Can Improve Survival in High-Risk Neuroblastoma Patients Not Treated with ASCT or Anti-GD2 Antibodies. Cancers 2021, 13, 3494. https://doi.org/10.3390/cancers13143494

AMA Style

Sun X, Zhen Z, Guo Y, Gao Y, Wang J, Zhang Y, Zhu J, Lu S, Sun F, Huang J, Cai R, Zhang Y, Liu J, Xiao Z, Zeng S, Liu Z. Oral Metronomic Maintenance Therapy Can Improve Survival in High-Risk Neuroblastoma Patients Not Treated with ASCT or Anti-GD2 Antibodies. Cancers. 2021; 13(14):3494. https://doi.org/10.3390/cancers13143494

Chicago/Turabian Style

Sun, Xiaofei, Zijun Zhen, Ying Guo, Yuanhong Gao, Juan Wang, Yu Zhang, Jia Zhu, Suying Lu, Feifei Sun, Junting Huang, Ruiqing Cai, Yizhuo Zhang, Juncheng Liu, Zizheng Xiao, Sihui Zeng, and Zhuowei Liu. 2021. "Oral Metronomic Maintenance Therapy Can Improve Survival in High-Risk Neuroblastoma Patients Not Treated with ASCT or Anti-GD2 Antibodies" Cancers 13, no. 14: 3494. https://doi.org/10.3390/cancers13143494

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