Rapid COJEC Induction Therapy for High-risk Neuroblastoma Patients – Cochrane Review^[*]

 

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Abstract

Background: Neuroblastoma is a rare malignant disease and patients with high-risk neuroblastoma have a poor prognosis. Rapid COJEC induction chemotherapy means (almost) the same total doses given within a shorter time period. In theory, rapid COJEC could reduce the risk of drug resistance and it has been considered as a potential candidate for improving the outcome.

Methods: The objective was to evaluate effects of rapid COJEC compared to standard induction chemotherapy in patients with high-risk neuroblastoma. We searched the databases CENTRAL, MEDLINE, and EMBASE from inception to 11 November 2014 and included randomized controlled trials.

Results: We identified one relevant randomized controlled trial with 130 participants receiving rapid COJEC and 132 participants receiving standard OPEC/COJEC induction chemotherapy. There was no statistically significant difference between the treatment groups in complete response (risk ratio 0.99, 95% confidence interval 0.71 to 1.38, P=0.94) and treatment-related mortality (risk ratio 1.21, 95% confidence interval 0.33 to 4.39, P=0.77). A statistically significant difference in favor of the standard treatment arm was identified for the following early toxicities: febrile neutropenia, septicemia, and renal toxicity.

Conclusion: The differences in complete response and treatment-related mortality between treatment alternatives were not statistically significantly different. Based on the currently available evidence, we are uncertain about the effects of rapid COJEC induction chemotherapy in patients with high-risk neuroblastoma.

Zusammenfassung

Hintergrund: Neuroblastoma ist eine seltene maligne Krankheit, und Patienten mit einem Hochrisikotumor haben eine ungünstige Prognose. Rapid COJEC ist eine Induktionschemotherapie, bei der (fast) die gleiche Gesamtdosis im Vergleich zum Standard in einem kürzeren Zeitraum gegeben wird. Es wird vermutet, dass rapid COJEC resistente Tumorzellen reduzieren und den Krankheitsverlauf günstig beeinflussen könnte.

Methoden: Es sollte bei Patienten mit Hochrisikotumor untersucht werden, ob sich rapid COJEC im Vergleich zum Standard auf den Behandlungserfolg auswirken kann. Wir suchten randomisierte Studien in den Datenbanken CENTRAL, MEDLINE und EMBASE, die dort jeweils bis zum 01. November 2014 aufgenommen waren.

Ergebnisse: Wir identifizierten eine relevante randomisierte Studie: 130 Teilnehmer erhielten rapid COJEC und 132 Teilnehmer erhielten den OPEC/COJEC Standard. Es zeigte sich kein statistisch signifikanter Unterschied zwischen beiden Behandlungsgruppen hinsichtlich des vollständigen Therapieansprechen (Risk-Ratio 0.99, 95% Konfidenzintervall 0.71 bis 1.38, P=0.94) und der behandlungsassoziierten Mortalität (Risk-Ratio 1.21, 95% Konfidenzinterval 0.33 bis 4.39, P=0.77). Ein statistisch signifikanter Unterschied wurde für folgende frühe Toxizitäten zum Vorteil der Standardgruppe identifiziert: fieberhafte Neutropenie, Sepsis und Nierentoxizität.

Schlussfolgerung: Der Unterschied hinsichtlich des vollständigen Therapieansprechens, und der behandlungsassoziierten Mortalität war jeweils nicht statistisch signifikant. Ausgehend von den momentan verfügbaren Studiendaten besteht eine Unsicherheit über die Wirkungen der rapid COJEC Induktionschemotherapie bei Patienten mit Hochrisiko-Neuroblastom.

^* This article is based on a Cochrane Systematic Review published in the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 5. Art. No.: CD010774. DOI: 10.1002/14651858.CD010774.pub2. (see www.thecochranelibrary.com for information). Cochrane Systematic Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.

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