EAPH-11. INTRAVENTRICULAR THERAPY ALTERNATING ETOPOSIDE, AQUEOUS CYTARABINE AND TOPOTECAN IS FEASIBLE AND SAFE: EXPERIENCE IN 26 PEDIATRIC PATIENTS WITH MALIGNANT BRAIN TUMORS

Abstract

BACKGROUND

Malignant brain tumors carry a high risk for leptomeningeal dissemination, but tumor cells floating in the CSF are often not affected by systemic and/or antiangiogenic chemotherapy. Since liposomal cytarabine was removed from the market, alternatives for intraventricular therapy are desperately needed. We report on our experience with an intraventricular therapy consisting of alternating cycles of etoposide, aqueous cytarabine and topotecan. PATIENTS AND

METHODS

Between 2008 and 2017, 26 patients aged 1 to 17 years (median 7 years) with various malignant brain tumors received intraventricular therapy via an Ommaya reservoir, consisting of alternating etoposide 0.5mg on five consecutive days (<1 year 0.25mg), topotecan 0.4mg twice a week (>1 and <2 years 0.25mg, >2 and <3 years 0.32mg) and aqueous cytarabin 30mg twice a week (<1 year 16mg, >1 and <2 years 20mg, >2 and <3 years 26mg).

RESULTS

1899 doses of etoposide (4–166/patient), corresponding to 2–36 five-day-cycles/patient (median 17), alternating with 307 doses of topotecan (1–49/patient, median 10), and 101 doses of aqueous cytarabine (1–28/patient, median 4) were administered. Treatment was given over a period of 1 – 115 months (median 12 months). Alternating intraventricular treatment was generally well tolerated. One boy with multiple recurrences of an ependymoma in the posterior fossa showed increased tremor after topotecan, another girl reported fatigue after topotecan.

CONCLUSION

Alternating intraventricular therapy with etoposide, aqueous cytarabine and topotecan is feasible and generally well tolerated, and can be an important addition for patients with malignant brain tumors.