ASCO - Shorter Chemo Interval Improves Ewing"s Sarcoma Outcome

By Megan Rauscher

NEW YORK MAY 19, 2008 (Reuters Health) - In patients with Ewing"s sarcoma, administering combination chemotherapy every 2 weeks rather than every 3 weeks (the standard) yields better results without an increase in toxicity, according to findings of a study released by the American Society of Clinical Oncology ahead of its annual meeting, which begins May 30th.

"These findings are convincing enough to change the standard of care for patients with localized Ewing"s sarcoma," lead investigator Dr. Richard B. Womer, of Children"s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, said in an ASCO-issued statement.

"This study shows that progress against Ewing"s sarcoma can be made by giving commonly used anti-cancer drugs in new ways," he added.

In the study, 568 patients with localized Ewing"s sarcoma received a total of 14 cycles of standard combination chemotherapy administered every 21 days or every 14 days. Chemotherapy consisted of vincristine, doxorubicin, and cyclophosphamide, alternating with ifosfamide and etoposide, with filgrastim between cycles. Primary treatment (surgery, radiation therapy, or both) began 13 weeks after chemotherapy was initiated.

According to Dr. Womer, after a median follow-up of 3 years, "the event-free survival was 76% among the patients who received chemotherapy every other week, compared with 65% who received chemotherapy every 3 weeks," a statistically significant difference.

"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."

"In fact, I would go so far as to say that, at least in many of the childhood cancers, most of the progress that has been made in the last 30 or 40 years -- and there has been considerable progress -- has been made...without introducing new drugs, but with better understanding of how to optimally use available drugs."


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