Treatment Paradigm

Question 1

What is the Tx paradigm for low-risk NB?

Answer 1

Low-risk NB Tx paradigm: Sg alone with chemo reserved for persistent or recurrent Dz.

Question 2

What is the Tx paradigm for low-risk stage 4S NB, and which study supports this approach?

Answer 2

Low-risk stage 4S NB Tx paradigm: Bx → supportive care. Chemo and/or RT are reserved for rapidly growing or symptomatic Dz. A subgroup analysis of CCG 3881 showed that supportive care is sufficient for 57% of pts. The protocol resulted in a 5-yr EFS of 86% and an OS of 92%. (Nickerson HJ et al., JCO 2000)

Question 3

What is the Tx paradigm for high-risk NB?

Answer 3

High-risk NB Tx paradigm: induction chemo, resection, high-dose chemo and stem cell transplant → consolidation RT, then oral cis-retinoic acid and immunotherapy (anti-GD2 + IL2/GM-CSF).

Question 4

What chemo drugs are typically used in NB?

Answer 4

Chemo drugs typically used in NB:

1. Cisplatin
2. Etoposide
3. Vincristine
4. Cyclophosphamide
5. Doxorubicin