Choroid plexus papilloma-A case highlighting the challenges of extrapolating pediatric chemotherapy regimens to adult populations

Stephen L. Barman, Gary W. Jean, William M. Dinsfriend, David E. Gerber

Research output: Contribution to journalArticle

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Abstract

The treatment of adults who present with rare pediatric tumors is not characterized well in the literature.We report an instance of a 40-year-old African American woman with a diagnosis of choroid plexus carcinoma admitted to the intensive care unit for severe sepsis seven days after receiving chemotherapy consisting of carboplatin (350 mg/m2 on Days 1 and 2 plus etoposide 100 mg/m2 on Days 1-5). Her laboratory results were significant for an absolute neutrophil count of 0/mL and blood cultures positive for Capnocytophagia species. She was supported with broad spectrum antibiotics and myeloid growth factors. She eventually recovered and was discharged in stable condition. The management of adults with malignancies most commonly seen in pediatric populations presents substantial challenges. There are multiple age-specific differences in renal and hepatic function that explain the need for higher dosing in pediatric patients without increasing the risk of toxicity. Furthermore, differences in pharmacokinetic parameters such as absorption, distribution, and clearance are present but are less likely to affect patients. It is expected that the pediatric population will have more bone marrow reserve and, therefore, less susceptible to myelosuppression. The extrapolation of pediatric dosing to an adult presents a problematic situation in treating adults with malignancies that primarily effect pediatric patients. We recommend extrapolating from adult treatment regimens with similar agents rather than extrapolating from pediatric treatment regimens to reduce the risk of toxicity. We also recommend the consideration of adding myeloid growth factors. If the treatment is tolerated without significant toxicity, dose escalation can be considered.

Original languageEnglish (US)
Pages (from-to)170-174
Number of pages5
JournalJournal of Oncology Pharmacy Practice
Volume22
Issue number1
DOIs
StatePublished - Feb 1 2016

Fingerprint

Choroid Plexus Papilloma
Pediatrics
Drug Therapy
Population
Intercellular Signaling Peptides and Proteins
Neoplasms
Carboplatin
Etoposide
Therapeutics
African Americans
Intensive Care Units
Sepsis
Neutrophils
Pharmacokinetics
Bone Marrow
Anti-Bacterial Agents
Kidney
Liver

Keywords

  • Chemotherapy
  • Choroid plexus papilloma
  • Dosing
  • Oncology
  • Pediatric hematology-oncology

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Oncology

Cite this

Choroid plexus papilloma-A case highlighting the challenges of extrapolating pediatric chemotherapy regimens to adult populations. / Barman, Stephen L.; Jean, Gary W.; Dinsfriend, William M.; Gerber, David E.

In: Journal of Oncology Pharmacy Practice, Vol. 22, No. 1, 01.02.2016, p. 170-174.

Research output: Contribution to journalArticle

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