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Vinblastine shows promise as first-line treatment for pediatric gliomas
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Vinblastine appeared well-tolerated in children with pediatric low-grade glioma, and it conferred OS and PFS outcomes similar to those of other treatments, according to data from a single-arm phase 2 study.
“The ideal chemotherapy regimen should have a similar PFS as earlier regimens, with little if any short- and long-term toxicity, and be able to be administered over a long period of time without cumulative toxicity,” Alvaro Lassaletta, MD, of The Hospital for Sick Children, Toronto, and colleagues wrote. “Single-agent vinblastine has shown promising activity and a low toxicity profile in patients with pediatric low-grade glioma who experienced treatment failure after initial treatment with chemotherapy and/or radiation.”
Lassaletta and colleagues studied the efficacy and toxicity of vinblastine as first-line treatment for children with progressive low-grade glioma. All children were chemotherapy and radiation naïve.
Researchers administered 6 mg/m2 of IV vinblastine once a week to patients aged younger than 18 years (n = 54) over the course of 70 weeks. The majority (55.5%) of patients had chiasmatic or hypothalamic tumors, and 24.1% had neurofibromatosis type 1.
Forty-seven patients (87%) achieved disease stabilization — defined as complete, partial or minor response, or stable disease — and 20% of patients with optic pathway glioma had improved vision.
The 5-year OS rate for the entire cohort was 94.4% (95% CI, 88.5-100), and the 5-year PFS rate was 53.2% (95% CI, 41.3-68.5). Patients with neurofibromatosis experienced a higher PFS rate than those without the condition (85.1% vs. 42%; P = .012).
The treatment generally was well tolerated.
None of the patients discontinued treatment due to toxicity. However, the dose was lowered to 5 mg/m2 for 16 (29.6%) patients, and to 4 mg/m2 for 17 (31.5%) patients.
“Vinblastine is easy to administer and inexpensive, has minimal short-term and long-term toxicity, and demonstrates a relatively maintained quality of life,” Lassaletta and colleagues wrote. “Hence, implementation of vinblastine chemotherapy as first-line treatment holds promise for all children and especially for those in middle- or low-income countries where financial restraints and treatment-related toxicities are major challenges.” – by Andy Polhamus
Disclosure: Lassaletta reports travel and accommodation expenses from Takeda Pharmaceuticals. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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