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西班牙巴塞隆纳Sant Joan de Deu医院的小儿肿瘤科主任Jaume Mora医师表示，一个西班牙的研究团队併用cisplatin和irinotecan，获得目前对小儿脑胶质瘤(brain gliomas)最好的反应；在18个恶化病童中，14 位(77%)在治疗后显示肿瘤缩小，这是此一病患类型中极杰出的反应。
Mora医师上週在巴塞隆纳举行的第14届欧洲癌症研讨会(ECCO 14)中发表这些结果；在该项研究的记者会中，ECCO总裁、荷兰Erasmus大学的Alexander Eggermont医师表示，在以前未曾发现过这种结果，这是初步观察，但18个病患已经足以证明此一新论点有效，我们还未改变临床实务 ，但我们必须继续探索此一新治疗方式。
Mora医师解释，在过去，脑胶质瘤的主要治疗方式是放射线治疗，手术并非实际选项，因為肿瘤通常位於威胁生命的解剖构造内，而瞄準脑部的放射线治疗会有长期的后遗症，因此朝向研发对这些病患化疗，不过，这类试验大多数都失败了，大部分的医学中心继续使用放射线治疗高等级的胶质瘤(high-grade gliomas)，对於低等级的胶质瘤(low-grade gliomas)，只有少数併用处方有显著效果，目前所用的是美国杜克大学发表的vincristine 和carboplatin，另外有一个义大利的研究团队指出cisplatin 和VP-16对低等级的胶质瘤有好的结果。
Mora医师在ECCO 14中所报告的结果，来自一项用irinotecan和cisplatin於18位恶化星状细胞瘤(astrocytoma)病童的第二期试验，这些病患中，6位病童有脊索肿瘤：2位有完整反应(CR)，4 位有部分反应(PR)；4位小孩有大脑天幕上(supratentorial)肿瘤，其中2位是PR、2位病情稳定(SD)；另外2位病童是小脑肿瘤(cerebellar tumors)，其中一位CR、另位一位是PR。<p>
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<td align="center" width="513"><b class="font3">Irinotecan和Cisplatin显示对小儿脑胶质瘤有快速反应</b></td>
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<p>西班牙巴塞隆纳Sant Joan de Deu医院的小儿肿瘤科主任Jaume Mora医师表示，一个西班牙的研究团队併用cisplatin和irinotecan，获得目前对小儿脑胶质瘤(brain gliomas)最好的反应；在18个恶化病童中，14 位(77%)在治疗后显示肿瘤缩小，这是此一病患类型中极杰出的反应。 <br>
<br>
Mora医师上週在巴塞隆纳举行的第14届欧洲癌症研讨会(ECCO 14)中发表这些结果；在该项研究的记者会中，ECCO总裁、荷兰Erasmus大学的Alexander Eggermont医师表示，在以前未曾发现过这种结果，这是初步观察，但18个病患已经足以证明此一新论点有效，我们还未改变临床实务 ，但我们必须继续探索此一新治疗方式。<br>
<br>
Mora医师解释，在过去，脑胶质瘤的主要治疗方式是放射线治疗，手术并非实际选项，因為肿瘤通常位於威胁生命的解剖构造内，而瞄準脑部的放射线治疗会有长期的后遗症，因此朝向研发对这些病患化疗，不过，这类试验大多数都失败了，大部分的医学中心继续使用放射线治疗高等级的胶质瘤(high-grade gliomas)，对於低等级的胶质瘤(low-grade gliomas)，只有少数併用处方有显著效果，目前所用的是美国杜克大学发表的vincristine 和carboplatin，另外有一个义大利的研究团队指出cisplatin 和VP-16对低等级的胶质瘤有好的结果。<br>
<br>
Mora医师在ECCO 14中所报告的结果，来自一项用irinotecan和cisplatin於18位恶化星状细胞瘤(astrocytoma)病童的第二期试验，这些病患中，6位病童有脊索肿瘤：2位有完整反应(CR)，4 位有部分反应(PR)；4位小孩有大脑天幕上(supratentorial)肿瘤，其中2位是PR、2位病情稳定(SD)；另外2位病童是小脑肿瘤(cerebellar tumors)，其中一位CR、另位一位是PR。<br>
<br>
剩下的6位病患有脑干胶质瘤(brain stem gliomas)，其中4位属於高等级(2位扩散、2 位未扩散)，另外2位是低等级的中脑肿瘤(mid-brain tumors)；Mora医师表示，脑干胶质瘤少见，但是最常发生於6到10岁小孩的癌症，存活率不佳，高等级脑干胶质瘤往往会致命，而低等级胶质瘤的病患通常可延长存活；此试验中，给予高等级肿瘤的小孩抗血管新生治疗药bevacizumab以及放射线治疗，另外加上irinotecan和cisplatin。 <br>
<br>
所有6个脑干胶质瘤的病童都显示对irinotecan 和cisplatin处方有快速临床反应，相当明显地，irinotecan/cisplatin处方在治疗结束时让所有病童的肿瘤减少20%以上，包括那些状况最差的脑干胶质瘤、体内扩散肿瘤；没有化学治疗方式可以在高等级脑干胶质瘤达到如此的早期反应。<br>
<br>
不过，在治疗后9到12个月，3位高等级肿瘤病患开始恶化。<br>
<br>
这个初步反应是有效的，但是不管我们给脑干病患哪种维持治疗，终究都还是会恶化；Mora医师表示，我们需要再度思考这些结果，和找出可以有这些初步反应的最好的併用方式。<br>
<br>
第14届欧洲癌症研讨会：摘要1407。发表於2007年9月25日。</p>
<p>Irinotecan and Cisplatin Show Rapid Response in Child Brain Gliomas <br>
<br>
The best responses seen to date in childhood brain gliomas have been reported by a Spanish group using a combination of cisplatin with irinotecan. Of 18 children with progressive disease, 14 (77%) showed a decrease in tumor size after treatment, which is an \"outstanding\" response in this patient group, says Jaume Mora, MD, PhD, head of pediatric oncology, Hospital Sant Joan de Deu, in Barcelona, Spain. <br>
<br>
<br>
Dr. Mora presented these results last week at the 14th European Cancer Conference (ECCO 14), in Barcelona. At a press conference at which the work was highlighted, Alexander Eggermont, MD, PhD, from Erasmus University, in Rotterdam, the Netherlands, and incoming ECCO president, said: \"This has never been seen before. It\'s an early observation, but 18 patients is a big enough group to make a statement that this is truly new and promising. We\'re not there yet in terms of changing clinical practice, but we should carry on exploring this new approach to treatment.\"<br>
<br>
Dr. Mora explained that, in the past, the main treatment for brain gliomas has been radiotherapy. Surgery is not really an option, because the tumors are often situated within life-threatening anatomical structures, but radiotherapy aimed at the brain has long-term adverse consequences, and so there has been a move toward exploring chemotherapy for these patients. \"However, most of these trials have failed,\" Dr. Mora commented, and most centers continue to use radiotherapy for high-grade gliomas. For low-grade gliomas, few combination regimens have shown significant changes in the natural history of the disease, but vincristine and carboplatin (pioneered in the United States at Duke University) are the current protocol, and an Italian group has reported good results in low-grade gliomas with cisplatin and VP-16, he said.<br>
<br>
The results that Dr. Mora reported at ECCO 14 came from a phase 2 trial of irinotecan and cisplatin in 18 children with progressing astrocytoma. Of these, 6 children had spinal cord tumors: 2 showed a complete response (CR), and 4 had a partial response (PR). Four children had supratentorial tumors, and 2 of these had a PR and 2 had stable disease (SD). Another 2 patients had cerebellar tumors, of which 1 had a CR and 1 had a PR. <br>
<br>
The remaining 6 patients had brain stem gliomas, 4 of which were high-grade (2 diffuse and 2 nondiffuse), and 2 had low-grade mid-brain tumors. Brain stem gliomas are rare, but they are among the commonest cancers to occur in children between 6 and 10 years old, Dr. Mora commented. Survival rates are poor, and high-grade brain stem gliomas are uniformly fatal, although children with low-grade gliomas have a more prolonged survival. In this trial, children with high-grade tumors were given the antiangiogenic therapy bevacizumab and radiotherapy in addition to irinotecan and cisplatin. <br>
<br>
All of the 6 children with brain stem gliomas showed a rapid clinical response to the irinotecan and cisplatin regimen. \"Remarkably, the irinotecan/cisplatin regimen achieved a reduction in tumor size greater than 20% in all the children at the end of therapy, including those with the worst brain stem gliomas, the intrinsic diffuse tumors. No chemotherapy has ever achieved this grade of early response in high-grade brain stem gliomas.\"<br>
<br>
However, between 9 and 12 months after the therapy, 3 of the high-grade tumors started to progress. <br>
<br>
\"This early response is promising, but the brain stem patients eventually progress regardless of the maintenance therapy we have given them. We need to rethink these results and find out how to better consolidate these initial responses,\" Dr. Mora said. <br>
<br>
剩下的6位病患有脑干胶质瘤(brain stem gliomas)，其中4位属於高等级(2位扩散、2 位未扩散)，另外2位是低等级的中脑肿瘤(mid-brain tumors)；Mora医师表示，脑干胶质瘤少见，但是最常发生於6到10岁小孩的癌症，存活率不佳，高等级脑干胶质瘤往往会致命，而低等级胶质瘤的病患通常可延长存活；此试验中，给予高等级肿瘤的小孩抗血管新生治疗药bevacizumab以及放射线治疗，另外加上irinotecan和cisplatin。
所有6个脑干胶质瘤的病童都显示对irinotecan 和cisplatin处方有快速临床反应，相当明显地，irinotecan/cisplatin处方在治疗结束时让所有病童的肿瘤减少20%以上，包括那些状况最差的脑干胶质瘤、体内扩散肿瘤；没有化学治疗方式可以在高等级脑干胶质瘤达到如此的早期反应。
不过，在治疗后9到12个月，3位高等级肿瘤病患开始恶化。
这个初步反应是有效的，但是不管我们给脑干病患哪种维持治疗，终究都还是会恶化；Mora医师表示，我们需要再度思考这些结果，和找出可以有这些初步反应的最好的併用方式。
第14届欧洲癌症研讨会：摘要1407。发表於2007年9月25日。
Irinotecan and Cisplatin Show Rapid Response in Child Brain Gliomas
The best responses seen to date in childhood brain gliomas have been reported by a Spanish group using a combination of cisplatin with irinotecan. Of 18 children with progressive disease, 14 (77%) showed a decrease in tumor size after treatment, which is an \"outstanding\" response in this patient group, says Jaume Mora, MD, PhD, head of pediatric oncology, Hospital Sant Joan de Deu, in Barcelona, Spain.
Dr. Mora presented these results last week at the 14th European Cancer Conference (ECCO 14), in Barcelona. At a press conference at which the work was highlighted, Alexander Eggermont, MD, PhD, from Erasmus University, in Rotterdam, the Netherlands, and incoming ECCO president, said: \"This has never been seen before. It\'s an early observation, but 18 patients is a big enough group to make a statement that this is truly new and promising. We\'re not there yet in terms of changing clinical practice, but we should carry on exploring this new approach to treatment.\"
Dr. Mora explained that, in the past, the main treatment for brain gliomas has been radiotherapy. Surgery is not really an option, because the tumors are often situated within life-threatening anatomical structures, but radiotherapy aimed at the brain has long-term adverse consequences, and so there has been a move toward exploring chemotherapy for these patients. \"However, most of these trials have failed,\" Dr. Mora commented, and most centers continue to use radiotherapy for high-grade gliomas. For low-grade gliomas, few combination regimens have shown significant changes in the natural history of the disease, but vincristine and carboplatin (pioneered in the United States at Duke University) are the current protocol, and an Italian group has reported good results in low-grade gliomas with cisplatin and VP-16, he said.
The results that Dr. Mora reported at ECCO 14 came from a phase 2 trial of irinotecan and cisplatin in 18 children with progressing astrocytoma. Of these, 6 children had spinal cord tumors: 2 showed a complete response (CR), and 4 had a partial response (PR). Four children had supratentorial tumors, and 2 of these had a PR and 2 had stable disease (SD). Another 2 patients had cerebellar tumors, of which 1 had a CR and 1 had a PR.
The remaining 6 patients had brain stem gliomas, 4 of which were high-grade (2 diffuse and 2 nondiffuse), and 2 had low-grade mid-brain tumors. Brain stem gliomas are rare, but they are among the commonest cancers to occur in children between 6 and 10 years old, Dr. Mora commented. Survival rates are poor, and high-grade brain stem gliomas are uniformly fatal, although children with low-grade gliomas have a more prolonged survival. In this trial, children with high-grade tumors were given the antiangiogenic therapy bevacizumab and radiotherapy in addition to irinotecan and cisplatin.
All of the 6 children with brain stem gliomas showed a rapid clinical response to the irinotecan and cisplatin regimen. \"Remarkably, the irinotecan/cisplatin regimen achieved a reduction in tumor size greater than 20% in all the children at the end of therapy, including those with the worst brain stem gliomas, the intrinsic diffuse tumors. No chemotherapy has ever achieved this grade of early response in high-grade brain stem gliomas.\"
However, between 9 and 12 months after the therapy, 3 of the high-grade tumors started to progress.
\"This early response is promising, but the brain stem patients eventually progress regardless of the maintenance therapy we have given them. We need to rethink these results and find out how to better consolidate these initial responses,\" Dr. Mora said.
14th European Cancer Conference: Abstract 1407. Presented September 25, 2007.
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