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Poster Display - 94
Sirolimus Combined With Chemotherapy as a Third-line Regimen for Relapsed or Refractory Yolk Sac Tumours in Children
Yixiang Song
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
Patients and methods: A retrospective analysis was conducted on the clinical data of children with relapsed or refractory YST and progressing conditions after receiving first- and second-line treatments who were undergoing S-TIC chemotherapy. The S-TIC regimen was as follows: oral sirolimus (1 mg/m²) on days 1-21, nab-paclitaxel (200 mg/m²) on day 1, ifosfamide (1200 mg/m²) on days 1-5, and carboplatin (500 mg/m²) on day 2. One cycle lasted for 3-4 weeks. Meanwhile, α-fetoprotein (AFP) was assessed every cycle and radiological assessment was performed every 2-3 cycles. The primary endpoint was the objective response rate (ORR) after four treatment cycles. Secondary endpoints included progression-free survival (PFS) rate, overall survival (OS), and safety profile.
Results: Twenty patients with multiple relapsed or refractory YST with a median age of 5 years received the S-TIC regimen. All patients received an average of 4.3 treatment cycles. Twelve (60%) patients achieved complete remission, six (30%) achieved partial remission, one (5%) achieved a stable disease, and one (5%) had a progressive disease after four treatment cycles. The ORR was 90%, the disease control rate was 95%, and the median follow-up time was 60 months. Four (20%) patients died of tumour progression, and the 5-year OS rate was 75%. Haematologic toxicity was the most common adverse reaction, with grades 3-4 neutropenia occurring in 95% of cases. Younger patients had a better OS than their older counterparts. Grades 3-4 toxicities and primarily neutropenia or thrombocytopenia were observed in 18 (95%) and 15 (75%) patients, respectively, and were considered acceptable for this patient population.
Conclusion: S-TIC treatment, with a very high ORR, may be an alternative regimen for children with multiple relapsed or refractory YST. Although the incidence of haematological adverse reactions is relatively high, it is controllable.