Adult Wilms' tumor: cisplatin and etoposide for relapse after adjuvant chemotherapy

Article Abstract:

Wilms' tumors, also called nephroblastomas, are kidney tumors that are composed of many different cell types, and thus resemble teratomas (congenital tumors with three primary germ layers). However, unlike germ-line tumors, Wilms' tumors involve only tissues that arise from the mesoderm (primary germ layer) of the developing embryo. Wilms' tumors are second only to neuroblastoma as a cause of malignancy in children, but are relatively rare in adults. Adults with Wilms' tumors have a poorer prognosis than children. Roughly 29 percent of adults have metastases (spread of cancer) at the time of initial diagnosis, in contrast to 10 percent metastases in children with this disease. Chemotherapeutic regimens that are useful in children are not as effective in adults. In a case of a 23-year-old woman with Wilms' tumor, cisplatin and etoposide were used successfully after the patient relapsed following adjuvant chemotherapy. The woman had received radiation and chemotherapy after the removal of her left kidney; chemotherapy consisted of vincristine and actinomycin. After nine months, a radiograph revealed a metastasis in the left lung. The patient was then given four cycles of doxorubicin. Almost a year later, radiography revealed further metastases in the lung. Cisplatin (100 mg per meter squared over 5 daily doses) and etoposide (300 mg per square meter over 5 daily doses) were then administered. The cycle was repeated after three weeks for a total of four cycles. Almost five years later, the patient remains free of disease and she has given birth to a healthy baby. This is the first report of a successful treatment of Wilms' tumor following relapse after adjuvant chemotherapy. Although neither cisplatin or etoposide are effective against Wilms' tumor individually, the combination has been shown to be efficacious in children, confirming other indications of a synergy between the two drugs. The present study indicates that this therapy can be effective in adults as well, and perhaps should be considered as a first-line treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Complete remission in refractory anaplastic adult Wilms' tumor treated with cisplatin and etoposide

Article Abstract:

Wilms' tumor, or nephroblastoma, is a cancer of primitive embryonal cells of the kidney. It is the fourth most common childhood tumor. About 350 cases of Wilms' tumor are diagnosed each year in the United States. Wilms' tumor may also afflict adults, but this is quite rare and the entire medical literature on adult Wilms' tumor consists of about 200 cases. When cancers are this infrequent, there is usually insufficient experience and data upon which to base an informed therapeutic decision. It is clear, however, that the prognosis of adult Wilms' tumor is poor, and that a child with a nephroblastoma of equivalent size and stage enjoys a better prognosis. Recently, however, attempts to treat Wilms' tumor in a 61-year-old woman achieved a complete remission. The patient presented with abdominal pain and blood in her urine; CT scan revealed a 12 centimeter necrotic mass in her left kidney. The mass was surgically removed and pathologic examination revealed that the tumor was consistent with the diagnosis of anaplastic Wilms' tumor. Another CT scan one year later revealed a mass and further enlargement of lymph nodes. The patient was treated with dactinomycin, doxorubicin, and vincristine, which failed to halt the progression of the cancer. However, a complete remission was achieved after treatment with cisplatin and etoposide. The patient has been monitored regularly with further CT scans, and at 18 months after completing chemotherapy she continues to be free of disease. This excellent response in an adult patient with an unfavorable histologic type of tumor suggests that the combination of cisplatin and etoposide warrants further scrutiny in the treatment of Wilms' tumor in adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies

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Etoposide, cyclophosphamide, cisplatin, and doxorubicin as neoadjuvant chemotherapy for osteosarcoma

Article Abstract:

Surgery is the first line of treatment for osteosarcoma, a form of bone cancer. However the survival of patients with osteosarcoma may be improved through the use of adjuvant chemotherapy, which can destroy tiny deposits of cancer cells not removed during surgery. Furthermore, the judicious use of adjuvant chemotherapy may permit conservative surgery to preserve limbs that in past years might have required amputation. The use of adjuvant chemotherapy in the treatment of osteosarcoma has been refined in a study involving 37 patients. The patients were treated with a chemotherapeutic protocol including etoposide, cyclophosphamide, cisplatin, and doxorubicin. The chemotherapeutic protocol began 10 weeks prior to surgical treatment and continued 34 weeks thereafter. The major toxic effect of this chemotherapeutic regimen was myelosuppression, the suppression of bone marrow function. However, there was no irreversible damage and no deaths occurred as a result of the treatment. None of the six patients who had known metastatic disease spread at the time of treatment were free of disease after two years. However, of the 31 patients without known metastases at diagnosis, 78 percent were alive without evidence of disease after two years. This relapse-free survival rate is as good as any which has been reported in the medical literature and indicates that the combination of etoposide, cyclophosphamide, cisplatin, and doxorubicin is as effective as any chemotherapeutic regimen yet evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Doxorubicin, Cyclophosphamide, Osteosarcoma

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