Ewing's Sarcoma: अगली पंक्ति का प्रबंधन जब VDC/IE कीमोथेरेपी ने आवश्यक प्रतिक्रिया प्राप्त नहीं की हो

DOI: 10.1038/s41416-024-02868-4

Multiple pairwise comparisons between arms have defined the following hierarchy based on EFS, OS and RECIST 1.1 imaging response after four cycles of chemotherapy, in order of decreasing efficacy: high dose ifosfamide, topotecan and cyclophosphamide, irinotecan and temozolomide, and gemcitabine and docetaxel.

The difference in absolute EFS and OS between topotecan/cyclophosphamide and irinotecan/temozolomide is small and there are significant differences in the toxicity profiles of each regimen, with a preponderance of myelotoxicity and neutropenic fever with ifosfamide and topotecan/cyclophosphamide, a small rate of significant encephalopathy and renal toxicity with ifosfamide and gastrointestinal toxicity with irinotecan/temozolomide.

High-dose chemotherapy followed by autologous stem cell rescue has not been evaluated in a randomised trial.

Several observational studies suggest a benefit in selected patients; it may be considered as consolidation therapy in the context of no or minimal residual disease, but its use remains controversial.