Treatment Outcome of Metastatic Neuroblastoma with Antiganglioside 2 Monoclonal Antibody (3F8): the Hong Kong Experience

Abstract

Purpose: The prognosis of metastatic neuroblastoma remains to be poor despiteintensive chemotherapy and radiation therapy. Immunotherapy with monoclonalantibody appears to provide an additional armamentarium to the current treatmentstrategy. We evaluated our experience in using this approach.Method: This is a prospective study from Jan 1996 to Dec 2007 and the results werecompared to our historical control from 1990 when a common data registry wasstarted. Uniform treatment protocol was adopted by 5 public hospitals since 1996. Ourtreatment was based on a modified N6 & N7 protocol adopted from MSKCC whichincluded intensive chemotherapyþautologous BMT þ/ immunotherapy withmurine monoclonal anti-ganglioside-2 antibody (3F8, anti-GD2 provided by MSKCCafter 1999) for patients with stage 4 neuroblastoma. The analysis of outcome was byKaplan-Meier analysis.Results: Within these 13 years, 61 children (all >12 months) with metastaticneuroblastoma were diagnosed. The 5 years PFS were 11.8% and 49.1% after treatedwith chemotherapy þ/ auto-PBSCT (n¼34) and chemotherapyþ auto-BMTþ3F8(n¼27) respectively (p¼0.009). Their median survival were 1.8 yrs vs. 4.9 yrsrespectively (p¼0.015). The most frequent encountered side effect of 3F8 wastransient but severe pain and allergic reaction. The median follow-up period is3.8 years and the minimal follow-up period is two year.Conclusion: Patients with stage 4 neuroblastoma treated with 3F8 antibody appearedto have a higher and longer survival as compared to the historical control. Other frompain which could readily be controlled with analgesic, the side effects were acceptablein our cohort.