With the sarcoma PNET, what would be suggestions for palliation after ˜Grier" protocol failure and temozolomide+irinotecan failure, in a metastatic young and fit patient?
No standard treatment. I frequently use topotecan + cyclofosfamide. ICE regímen can hold the disease progressivos for a while, but with more AE.
I know it is a proposal to the limits, for which we need to evaluate the clinical situation in detail, but why not consider a 68Ga PET for a possible PRRT?
No standard treatment. You could use VCR, topotecan, Cyclophosphamide. we pulished the results in the Manuscript: Kebudi R, Çakır FB, Agaoglu FY, Görgün Ö, Darendeliler E. A Modified Protocol with Vincristine, Topotecan and Cyclophosphamide for Recurrent/Progressive Ewing Sarcoma Family Tumors. Pediatric Hematology and Oncology 30:170–177, 2013
or ICE
or gemcitabine, docetaxel.
For palliativ therapy maybe one should consider less toxic treatment. In similar cases we often employ metronomic therapy eg according to Robison et al. Pediatric Blood Cancer 61 (4) 2014. They used continuous oral celecoxib, thalidomide, and fenofibrate, with alternating 21-day cycles of low-dose cyclophosphamide and etoposide.
The most active agents include vincristine, actinomycin D, high dose cyclophosphamide, doxorubicine, ifosfamide , topotecan and etoposide. The combinations of these drugs are effective in progressive and recurrent PNET
Thank you for all your efforts to help.
Most of the cited drugs the patient had been exposed to. Unfortunately, he died during after 2nd treatment, and received good and possibles supportive and palliative care. Regards.
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