Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors
IntroductionIn neuro-oncological pediatric patients under 3 years of age, chemotherapy intensified to high doses (high-dose chemotherapy, HDC) represents the cornerstone to avoid the potential toxicity of radiotherapy. Combination treatment with gemcitabine–oxaliplatin (GemOx) was administered for i...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-05-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1476411/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850190116048338944 |
|---|---|
| author | Barbara Castelli Carla Fonte Marco Tellini Marco Di Nicola Milena Guidi Laura Giunti Bianca Tirinnanzi Chiara Marzano Anna Maria Buccoliero Ludovico D’Incerti Flavio Giordano Mirko Scagnet Veronica Tintori Lorenzo Genitori Iacopo Sardi |
| author_facet | Barbara Castelli Carla Fonte Marco Tellini Marco Di Nicola Milena Guidi Laura Giunti Bianca Tirinnanzi Chiara Marzano Anna Maria Buccoliero Ludovico D’Incerti Flavio Giordano Mirko Scagnet Veronica Tintori Lorenzo Genitori Iacopo Sardi |
| author_sort | Barbara Castelli |
| collection | DOAJ |
| description | IntroductionIn neuro-oncological pediatric patients under 3 years of age, chemotherapy intensified to high doses (high-dose chemotherapy, HDC) represents the cornerstone to avoid the potential toxicity of radiotherapy. Combination treatment with gemcitabine–oxaliplatin (GemOx) was administered for infant- type cerebral tumors as a bridge toward autologous hematopoietic transplantation to achieve clinical and neuroradiological permissiveness to HDC and to raise the possibility of second-look neurosurgery. MethodsFrom May 2017 to May 2023, at Meyer Children’s Hospital IRCSS in Florence (Italy), four patients, with a median age of 19 months (with two high- grade gliomas, a metastatic medulloblastoma, and a choroid plexus carcinoma CNS WHO grade 3), were subjected to partial neurosurgical removal and induction therapy delivered according to the Italian program for malignant cerebral tumors under 3 years. To delay HDC, either for disease reassessment or for temporary unfitness, GemOx cycles were administered. Gemcitabine 1,000 mg/m2 and oxaliplatin 100 mg/m2 were given on day 1 every 21–28 days for one to six cycles. ResultsThe treatment was well tolerated overall, except for severe platelet hematological toxicity in a patient, which required dose reduction to 75%. After GemOx, one patient was also subjected to further neurosurgery. Bridge therapy made it possible to submit patients to HDC in safety, in permissive clinical conditions, and after assessment of disease stability. ConclusionIn infant-type cerebral tumors eligible for HDC, GemOx could be a possible strategy in the case of post-induction residual disease to exclude uncertain evolution or when waiting for clinical suitability for second surgery and intensified treatment. The therapy was overall safe and well tolerated. This approach resulted incisive in the therapeutic or palliative choice for extremely young patients with aggressive brain tumors. |
| format | Article |
| id | doaj-art-024fa22d6a4e4afca18cee56462e71fc |
| institution | OA Journals |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-024fa22d6a4e4afca18cee56462e71fc2025-08-20T02:15:24ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-05-011510.3389/fonc.2025.14764111476411Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumorsBarbara Castelli0Carla Fonte1Marco Tellini2Marco Di Nicola3Milena Guidi4Laura Giunti5Bianca Tirinnanzi6Chiara Marzano7Anna Maria Buccoliero8Ludovico D’Incerti9Flavio Giordano10Mirko Scagnet11Veronica Tintori12Lorenzo Genitori13Iacopo Sardi14Neuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyPathology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyRadiology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeurosurgery Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeurosurgery Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyPediatric Hematology/Oncology and HSCT Department, Meyer Children’s Hospital IRCCS, Florence, ItalyNeurosurgery Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyNeuro-Oncology Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyIntroductionIn neuro-oncological pediatric patients under 3 years of age, chemotherapy intensified to high doses (high-dose chemotherapy, HDC) represents the cornerstone to avoid the potential toxicity of radiotherapy. Combination treatment with gemcitabine–oxaliplatin (GemOx) was administered for infant- type cerebral tumors as a bridge toward autologous hematopoietic transplantation to achieve clinical and neuroradiological permissiveness to HDC and to raise the possibility of second-look neurosurgery. MethodsFrom May 2017 to May 2023, at Meyer Children’s Hospital IRCSS in Florence (Italy), four patients, with a median age of 19 months (with two high- grade gliomas, a metastatic medulloblastoma, and a choroid plexus carcinoma CNS WHO grade 3), were subjected to partial neurosurgical removal and induction therapy delivered according to the Italian program for malignant cerebral tumors under 3 years. To delay HDC, either for disease reassessment or for temporary unfitness, GemOx cycles were administered. Gemcitabine 1,000 mg/m2 and oxaliplatin 100 mg/m2 were given on day 1 every 21–28 days for one to six cycles. ResultsThe treatment was well tolerated overall, except for severe platelet hematological toxicity in a patient, which required dose reduction to 75%. After GemOx, one patient was also subjected to further neurosurgery. Bridge therapy made it possible to submit patients to HDC in safety, in permissive clinical conditions, and after assessment of disease stability. ConclusionIn infant-type cerebral tumors eligible for HDC, GemOx could be a possible strategy in the case of post-induction residual disease to exclude uncertain evolution or when waiting for clinical suitability for second surgery and intensified treatment. The therapy was overall safe and well tolerated. This approach resulted incisive in the therapeutic or palliative choice for extremely young patients with aggressive brain tumors.https://www.frontiersin.org/articles/10.3389/fonc.2025.1476411/fullbrain tumorsgemcitabineoxaliplatinhigh-dose chemotherapyautologous stem cell transplantationpediatric oncology |
| spellingShingle | Barbara Castelli Carla Fonte Marco Tellini Marco Di Nicola Milena Guidi Laura Giunti Bianca Tirinnanzi Chiara Marzano Anna Maria Buccoliero Ludovico D’Incerti Flavio Giordano Mirko Scagnet Veronica Tintori Lorenzo Genitori Iacopo Sardi Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors Frontiers in Oncology brain tumors gemcitabine oxaliplatin high-dose chemotherapy autologous stem cell transplantation pediatric oncology |
| title | Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors |
| title_full | Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors |
| title_fullStr | Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors |
| title_full_unstemmed | Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors |
| title_short | Gemcitabine–oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant-type brain tumors |
| title_sort | gemcitabine oxaliplatin as a bridge therapy toward autologous hematopoietic stem cell transplantation in infant type brain tumors |
| topic | brain tumors gemcitabine oxaliplatin high-dose chemotherapy autologous stem cell transplantation pediatric oncology |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1476411/full |
| work_keys_str_mv | AT barbaracastelli gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT carlafonte gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT marcotellini gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT marcodinicola gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT milenaguidi gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT lauragiunti gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT biancatirinnanzi gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT chiaramarzano gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT annamariabuccoliero gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT ludovicodincerti gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT flaviogiordano gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT mirkoscagnet gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT veronicatintori gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT lorenzogenitori gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors AT iacoposardi gemcitabineoxaliplatinasabridgetherapytowardautologoushematopoieticstemcelltransplantationininfanttypebraintumors |