Faster Chemotherapy Helps Children With Rare Ewing's Cancer

[Mary]

Faster Chemotherapy Helps Children With Rare Ewing's Cancer
By Tom Randall

May 15 (Bloomberg) -- Boosting the frequency of chemotherapy helped children recover from a rare form of bone cancer without increasing side effects, a study found.

Children who received a chemotherapy every two weeks instead of the standard treatment of every three weeks were more likely to recover from the bone disease called Ewing's Sarcoma. About 76 percent of those taking the new regimen were living without the disease three years after treatment compared with 65 percent of those taking standard therapy.

Ewing's sarcoma most often develops during puberty and in its early stages can cause pain and swelling near tumors, usually appearing in the long bones of the arms and legs, chest or pelvis, according to the U.S. National Institutes of Health. It affects as many as six adolescents out of 1 million, according to the researchers. The disease is treated with chemotherapy plus radiation therapy or surgery, and survival varies depending on how early the cancer is detected.

``These findings are convincing enough to change the standard of care,'' said Richard Womer, lead author of the study and professor of pediatrics at the Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine. ``This study shows that progress against Ewing's sarcoma can be made by giving commonly used anti-cancer drugs in new ways.''

The study compared 284 patients who received chemotherapy every two weeks and 284 who received the same regimen every three weeks. Patients in both groups received 14 cycles of chemotherapy.

The data was released today by the American Society of Clinical Oncology. The report was one of five highlighted by the cancer group ahead of its five-day annual meeting scheduled to begin May 30.

[Cindi]

My oncologist and I were just discussing this.  The pediatric regimen at Stanford is already following this protocol.  Unfortunately, most adults can't tolerate that regimen...we all know children's resilience is much better than adults.  Considering I am in mid-treatment I will ask again if my protocol could be changed.  Thanks for all the great information you are sharing with us...it sounds like you had a great time and received a wealth of knowledge.

Staying strong-
Cindi

[Larisa]

We also discussed this protocol with our oncologist. And he had the same concern. This protocol is harder even on children. Side effects include nails falling off and skin peeling off the feet (all I remember)...

[Mary]

It sounds like this protocol is really tough! Nails falling off- oh my. I don't think I would try it, and I definitely wasn't suggesting that adults should follow this protocol. But I thought I should put it out there for everyone. I'm glad you folks are talking with your docs!

What I really hope is that researchers can find a chemo that is more targeted and less toxic than the ones they're giving now. That would be the dream! It's happening for other cancers, so hopefully instead of pumping us up with these same drugs at a faster rate, another option will be here soon.

[Mary]

Well, this is interesting. This article states:
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"We were gratified and a little bit surprised to find that the toxicity did not increase as we decreased the interval between chemotherapy cycles," Dr. Womer added. Fever with neutropenia occurred in 7% of patients in the 2-week arm and 6% of those in the 3-week arm; the incidence of infection was 4.8% and 4.6%, respectively.

This study, he said, shows that "every 2-week chemotherapy is practical (and) more effective than every 3-week chemotherapy for localized Ewing's sarcoma, and there is no associated increase in toxicity."

Commenting on the study, ASCO president-elect Dr. Richard L. Schilsky said: "This study shows that by taking the currently available chemotherapy drugs and intensifying their use, we can get better results."

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So I am confused...does the toxicity not increase in children, but it does increase in adults? Larisa or Cindi, what have your doctors said? Are they assuming that toxicity increases, have they seen it, or what? I'm definitely curious.

[Larisa]

We were given a copy of this protocol (well over 100 pages) right after we got the diagnosis. I'll ask Victor if he still has it, because he is the one who read it through and briefed me .

[Cindi]

Mary...my oncologist did not mention a concern with toxicity increasing.  What she explained is that adults have a more difficult time rebounding in between treatments.  Usually a 2 week window does not allow our counts to be where they need to be in order to receive chemo.  I am in between rounds right now...when I meet with her next I will discuss this with her.

Staying strong-
Cindi

[Mary]

Thanks for the clarification, Cindi. If bouncing back in between treatments is the issue - that makes sense!

[Brett]

I'm on the chemotherapy every two weeks protocol.  I received it from Mayo when we went up for a consultation prior to starting chemo and I'm glad we did it as it appears as though it is more effective.

Thus far, it hasn't been too difficult for me to rebound after each chemo and I've completed six rounds.  I do receive neupogen shots between rounds to boost my white blood cell count and I typically receive two units of blood after each round.

[Kelly_Marie]

Brett- have you started the radiation treatment?  I'm interested to know if that part of the protocol will still be ok for your body to rebound?  My interest is purely selfish- I was put on the 2 week protocol as I was apart of Southern Calif. research on such different treament in 1996.  I too was ok but then when the radiation with chemo treatment began I didn't do too well. Ok actually I continued to have nuetropenic fevers-felt like I never left the hospital.  I'd be admitted due to the fever, remain in the hospital-be wheeled to radiation so not to loose the momentum of that treatment- need platelets- 2 weeks go by and remain in hopsital for chemo.   The thing is on the 11 round, meaning I was to begin the 11 round my white and reds never recovered.  I was on neupogen, epogen shots, they sent me home, waited 4 weeks even when after 3 monthes they signed me out as being saturated.  They said that meant according to my body it was saturated with the amount of Chemo to be given as the white/reds never came back. 

Strange as I feared I would not be given the entire protocol but then happy I would not be given any more treatment.  It took 5 years for the blood tests to register the white/red blood cells low but at least within the range of safe enough I did not have to panic whenever someone coughed around me.  Other side effects are with me daily but I'm not complaining too much as I am alive! For me I need to give all the credit to God! 

Blessings,
Kelly Marie