Safety assessment of intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in the treatment of Ewing tumors in the EURO‐E.W.I.N.G. 99 clinical trial

Abstract

Background: The EUROpean Ewing tumour Working Initiative of National Groups 1999 (EURO‐E.W.I.N.G. 99) protocol prescribes six courses of vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) as intensive induction chemotherapy for Ewing tumors (ET). Granulocyte‐colony stimulating factor (G‐CSF) is recommended. Adverse reactions (AR) were evaluated; quality assurance of data collection reviewed. Procedure: Safety data from 4,746 courses of VIDE in 851 patients less than 50 years with ET were collected using a checklist and evaluated using descriptive statistics with sub‐groups including gender, age, and tumor volume, analyzed by Wilcoxon and Kruskal–Wallis tests. Results: Myelosuppression and infections were the major AR but with appropriate supportive therapy targeted dose intensity was maintained. Five VIDE‐related deaths with three due to sepsis were reported. Renal and cardiac toxicity were reflected by glomerular filtration rate (GFR) <39 ml/min/1.73m 2 in 0.1%, tubular phosphate reabsorption ≤0.80 in 1.9%, and left ventricular shortening fracture <28% in 2.5% VIDE courses. Statistically significant gender‐associated AR concerning hemoglobin and platelets were observed with females > males as were age‐associated AR concerning hemoglobin, WBC, platelets, stomatitis, and vomiting with AR decreasing with age, that is, children > adolescents > adults. No association of AR to tumor volume was found. In VIDE courses with and without G‐CSF, neutropenia‐related fever in 60.8% and 65.8%, and infection in 54.7% and 61.0% courses, respectively, were recorded. Conclusions: AR under VIDE remained within the expected range. Some AR, for example, hematotoxicity were significantly influenced by age and gender but not by tumor volume. G‐CSF did not significantly influence neutropenia‐related fever and infection. Solicited safety collection with checklists adequately reflects the burden per course. Pediatr Blood Cancer © 2006 Wiley‐Liss, Inc.