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| |  AAO: Carboplatin-Vincristine Regimen Without Etoposide Treats Paediatric Intraocular Retinoblastoma By Deanna M Green, PhD ANAHEIM, CA -- November 20, 2003 -- Etoposide is not necessary to treat children with intraocular retinoblastoma when a regimen of carboplatin and vincristine is administered with coordinate focal therapy, according to findings presented here November 16th at the 2003 Annual Meeting of the American Academy of Ophthalmology. A previous study showed that a 3-drug regimen consisting of carboplatin, viscristine, and etoposide without local control did not successfully treat patients with intraocular retinoblastoma. This treatment was associated with high salvage and complication rates and a significant requirement for external beam radiation (EBRT) and enucleation. A modified approach was proposed that initiated focal consolidation before disease progression occurred. The new approach also sought to eliminate the use of etoposide, which has a high risk of bone-marrow suppression and secondary leukaemia. Matthew W. Wilson, MD, and colleagues, University of Tennessee Health Sciences Centre and St. Jude's Children's Hospital, Memphis, United States, evaluated ocular survival after vincristine and carboplatin chemotherapy with intensive focal treatments in children with retinoblastoma. The study included 21 children between the ages of 2 weeks and 37 months (median age 14 months) with intraocular retinoblastoma. Patients were treated with a combination of vincristine and carboplatin followed by a median of 5 focal treatments after the first course of chemotherapy. Notably, 4 patients in the study also required etoposide for various reasons. Follow-up data were collected on the ocular survival and avoidance of EBRT or enucleation events in 36 eyes. All patients responded to chemotherapy. Treatment-related adverse events included transient myelosuppression and occasional severe fever. There were, however, no signs of metastatic disease and no deaths occurred during chemotherapy. Overall, 43.5% of patients had an event-free survival at follow-up. EBRT was required in 13 eyes at a mean of 6 months, 9 of which had Reese-Ellsworth Group IV-V disease. The 2-year incidence of EBRT in this group was 39.4%. Furthermore, 9 eyes were enucleated at a mean period of 16 months; all were group IV-V. Ocular survival at 3 years was 75% compared to 70% seen in the 3-drug etoposide-containing regimen study. Dr. Wilson noted, "There was no significant difference in ocular and event-free survival with this treatment protocol as compared to one that included the addition of etoposide with no focal treatment." He also added, however, that a greater percentage of eyes were saved in the current study. Dr. Wilson concluded, "This regimen achieved similar results using a less toxic 2-drug regimen." He said, "Etoposide is not necessary and should be avoided."
[Study Title: Improved Ocular Survival for Retinoblastoma With a Two-Drug Regimen and Intensive Focal Treatments. Abstract PA010]
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