Children treated with metronomic chemotherapy in a low-income country: METRO-MALI-01.

BACKGROUND: Metronomic chemotherapy (MC) is defined as the frequent administration of chemotherapy at doses below the maximal tolerated dose and with no prolonged drug-free break. As off-patent chemotherapeutic drugs can be used and given the low toxicity profile of this approach, MC seems to be well adapted to low-income countries. OBJECTIVE: The aim of this study was to assess the efficacy and safety of a vincristine/cyclophosphamide/methotrexate MC regimen given to children with refractory cancer of various tumor types. METHODS: This prospective, pilot, single-center study evaluated the use of MC with a first cycle consisting of weekly vincristine (1.5 mg/m) on days 1, 8, 15, and 22, daily cyclophosphamide (25 mg/m) on days 1 to 21, and twice weekly methotrexate (15 mg/m) on days 21 to 42, followed by a 1-week break. For the following cycles, vincristine was administered only at weeks 1 and 5 of the cycle. This treatment was proposed to children with refractory cancer following treatments with the standard protocols available in our institution and to patients who were not eligible for the protocol. Adverse events were determined through laboratory analyses and investigator observations. RESULTS: From November 2008 to December 2009, 12 children (median age, 3.7 y; range, 2 to 7 y) were included. The most frequent diagnoses were Wilms tumors (6) and retinoblastoma (5). No objective response was observed, but 7 patients experienced disease stabilization (58%) and continued their treatment for 15 to 24 weeks. After a median follow-up of 39 weeks, 6 patients (50%) were alive. Most importantly, in 3 patients (25%), disease remained stable for at least 6 months after completion of treatment. One grade 4 anemia was observed in 1 patient and 1 grade 4 nonfebrile neutropenia in 1 patient. No other grade 3 or 4 toxicities were noted. CONCLUSION: The MC regimen that we report here was well tolerated and was associated with disease stabilization. Most importantly, stabilization could be maintained for over 6 additional months after completion of treatment in 3 patients. The potential of MC in children and young adults in low-income countries warrants further studies.

A 30-month prospective study on the treatment of retinoblastoma in the Gabriel Toure Teaching Hospital, Bamako, Mali.

INTRODUCTION: Retinoblastoma is one of the most common malignant tumours among children in Africa. However, very few studies on this disease have been published, especially studies from French-speaking countries in Africa. PATIENTS AND METHODS: Prospective study over a period of 30 months from 1 January 2005 to 30 June 2007 on all cases of retinoblastoma diagnosed and treated in the Paediatric Oncology Unit of the Gabriel Touré Hospital in Bamako, Mali. Treatment was two courses of pre-operative chemotherapy (cyclophosphamide, adriamycine and vincristine), enucleation for many patients, and then two courses of adjuvant chemotherapy with the same drugs. RESULTS: During the study period, 55 cases of retinoblastoma were treated, which represents 33.1% of all the solid tumours, coming second in frequency after lymphomas (39.7%). The mean age of the patients was 4.2 years. Boys were the most affected, with a sex ratio of 2:1. Forty-nine mothers (89.1%) and 46 fathers (83.6%) had no formal education. Thirty-seven children (67.3%) were from rural areas. Unilateral cases were predominant (49 cases (89.1%)). Ten cases (10.9%) were bilateral. Exophthalmos was the leading symptom (30 cases (54.5%)). The survival rate at 30 months was 56% with 18% lost at follow-up. CONCLUSION: Mortality as a result of retinoblastoma remains high in our region because diagnosis is always late and it is difficult to follow-up the patients. Education of healthcare workers and raising awareness in the general population would improve the survival rate of retinoblastoma patients in Africa.