PMID- 37098238 OWN - NLM STAT- MEDLINE DCOM- 20230609 LR - 20231222 IS - 1527-7755 (Electronic) IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 41 IP - 17 DP - 2023 Jun 10 TI - Survival of Patients With Neuroblastoma After Assignment to Reduced Therapy Because of the 12- to 18-Month Change in Age Cutoff in Children's Oncology Group Risk Stratification. PG - 3149-3159 LID - 10.1200/JCO.22.01946 [doi] AB - PURPOSE: In 2006, Children's Oncology Group (COG) reclassified subgroups of toddlers diagnosed with neuroblastoma from high-risk to intermediate-risk, when the age cutoff for high-risk assignment was raised from 365 days (12 months) to 547 days (18 months). The primary aim of this retrospective study was to determine if excellent outcome was maintained after assigned reduction of therapy. PATIENTS AND METHODS: Children <3 years old at diagnosis, enrolled on a COG biology study from 1990 to 2018, were eligible (n = 9,189). Assigned therapy was reduced for two cohorts of interest on the basis of the age cutoff change: 365-546 days old with International Neuroblastoma Staging System (INSS) stage 4, MYCN not amplified (MYCN-NA), favorable International Neuroblastoma Pathology Classification (INPC), hyperdiploid tumors (12-18mo/Stage4/FavBiology), and 365-546 days old with INSS stage 3, MYCN-NA, and unfavorable INPC tumors (12-18mo/Stage3/MYCN-NA/Unfav). Log-rank tests compared event-free survival (EFS) and overall survival (OS) curves. RESULTS: For 12-18mo/Stage4/FavBiology, 5-year EFS/OS (+/- SE) before (2006; n = 55) assigned reduction in therapy was similar: 89% +/- 5.1%/89% +/- 5.1% versus 87% +/- 4.6%/94% +/- 3.2% (P = .7; P = .4, respectively). For 12-18mo/Stage3/MYCN-NA/Unfav, the 5-year EFS and OS were both 100%, before (n = 6) and after (n = 4) 2006. The 12-18mo/Stage4/FavBiology plus 12-18mo/Stage3/MYCN-NA/Unfav classified as high-risk 2006 had an EFS/OS of 88% +/- 4.3%/95% +/- 2.9% versus 88% +/- 0.9%/95% +/- 0.6% for all other intermediate-risk patients <3 years old (P = .87; P = .85, respectively). CONCLUSION: Excellent outcome was maintained among subsets of toddlers with neuroblastoma assigned to reduced treatment after reclassification of risk group from high to intermediate on the basis of new age cutoffs. Importantly, as documented in prior trials, intermediate-risk therapy is not associated with the degree of acute toxicity and late effects commonly observed with high-risk regimens. FAU - Bender, Hannah G AU - Bender HG AUID- ORCID: 0000-0003-0914-7212 AD - Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA. FAU - Irwin, Meredith S AU - Irwin MS AUID- ORCID: 0000-0002-2452-5181 AD - Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada. FAU - Hogarty, Michael D AU - Hogarty MD AUID- ORCID: 0000-0002-9221-4852 AD - Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. FAU - Castleberry, Robert AU - Castleberry R AD - University of Alabama Birmingham, Birmingham, AL. FAU - Maris, John M AU - Maris JM AUID- ORCID: 0000-0002-8088-7929 AD - Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. FAU - Kao, Pei-Chi AU - Kao PC AUID- ORCID: 0000-0003-0702-8324 AD - Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA. FAU - Zhang, Fan F AU - Zhang FF AUID- ORCID: 0000-0002-1606-7766 AD - Department of Biostatistics, Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL. FAU - Naranjo, Arlene AU - Naranjo A AUID- ORCID: 0000-0001-7737-4324 AD - Department of Biostatistics, Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL. FAU - Cohn, Susan L AU - Cohn SL AUID- ORCID: 0000-0001-5749-7650 AD - Department of Pediatrics and Comer Children's Hospital, University of Chicago, Chicago, IL. FAU - London, Wendy B AU - London WB AUID- ORCID: 0000-0003-3571-6538 AD - Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA. LA - eng GR - U24 CA196173/CA/NCI NIH HHS/United States GR - R35 CA220500/CA/NCI NIH HHS/United States GR - U10 CA098413/CA/NCI NIH HHS/United States GR - U10 CA098543/CA/NCI NIH HHS/United States GR - U10 CA180899/CA/NCI NIH HHS/United States GR - U10 CA180886/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230425 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 RN - 0 (N-Myc Proto-Oncogene Protein) SB - IM CIN - Transl Pediatr. 2023 Nov 28;12(11):1926-1930. PMID: 38130585 MH - Humans MH - Infant MH - Child, Preschool MH - Prognosis MH - N-Myc Proto-Oncogene Protein/genetics MH - Retrospective Studies MH - Disease-Free Survival MH - Neoplasm Staging MH - *Neuroblastoma/pathology MH - Risk Assessment PMC - PMC10256433 COIS- The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center. Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments). Wendy B. London Consulting or Advisory Role: Jubilant Radiopharma, Merck, Healthcasts, Y-mAbs Therapeutics, Inc Research Funding: Agios, Bristol Myers Squibb, Novartis, Aileron Therapeutics, Bluebird Bio No other potential conflicts of interest were reported. EDAT- 2023/04/25 18:42 MHDA- 2023/06/09 06:42 PMCR- 2024/06/10 CRDT- 2023/04/25 16:03 PHST- 2024/06/10 00:00 [pmc-release] PHST- 2023/06/09 06:42 [medline] PHST- 2023/04/25 18:42 [pubmed] PHST- 2023/04/25 16:03 [entrez] AID - JCO.22.01946 [pii] AID - 10.1200/JCO.22.01946 [doi] PST - ppublish SO - J Clin Oncol. 2023 Jun 10;41(17):3149-3159. doi: 10.1200/JCO.22.01946. Epub 2023 Apr 25.