Treatment of childhood astrocytomas with irinotecan and cisplatin

Previously we described the outcome of children with spinal cord astrocytoma treated with irinotecan and cisplatin (I/C). We here report the review of the initial institutional experience using this combination for children with low-grade glioma (LGG). I/C chemotherapy consisted of weekly cisplatin (30 mg/m(2)) and irinotecan (50-65 mg/m(2)) for a total maximum of 16 doses, administered in an outpatient basis. Between November 2002 and December 2009, 46 children (median age 6.3 years; range 0.3-17.7) with glioma were treated. We here report the cohort of 31 patients with LGG. Patients received a median of 16 cycles of I/C (range 8-16). The overall objective response [complete response (CR) + partial response (PR)] and disease control (CR + PR + stable disease) rates to I/C treatment were 6.5% [95% confidence interval (CI), 0.8-21.4%] and 93.5% (95% CI 78.6-99.2%), respectively. Disease control persisted for a median of 65 months. Toxicity was predominantly myelosuppression only seen in heavily pretreated patients. Survival analysis shows 5-year event-free survival (EFS) of 54% and 5-year overall survival (OS) of 80%. I/C chemotherapy produced disease control and clinical improvement in a majority of children with low-grade glioma, with manageable toxicity.