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Retrospective National “Real Life” Experience of the SFCE with the Metronomic MEMMAT and MEMMAT-Like Protocol

Some more data about the MEMMAT approach for relapsing/refractorty pediatric brain tumors confirming the potential of MEMMAT after the recent publication from the Irene Slavc team !! Ideed, the Société Française de lutte contre les Cancers de l’Enfants et l’adolescent (SFCE) has just published in JCM. The article entitled : Retrospective National “Real Life” Experience of the SFCE with the Metronomic MEMMAT and MEMMAT-Like Protocol has been co-authored by Camille Winnicki ,Pierre Leblond, Franck Bourdeaut, Anne Pagnier, Gilles Paluenzela, Pascal Chastagner ,Gwenaelle Duhil-De Benaze ,Victoria Min,Hélène Sudour-Bonnange, Catherine Piette ,Natacha Entz-Werle,Sylvie Chabaud and Nicolas André from Children Hospital of La Timone, Assistance Publique Hôpitaux de Marseille, SIREDO Pediatric Oncology Center, Curie, University Hospital of Grenoble, Centre Hospitalo-Universitaire de Montpellier, University Hospital of Nancy, Centre Hospitalier Universitaire of Nice, Oscar-Lambret Center Lille, Centre Hospitalo-Universitaire de Liège, Centre Léon Bérard Lyon and MGHI.

Relapses in pediatric high-risk brain tumors remain unmet medical needs. Over the last 15 years, metronomic chemotherapy has gradually emerged as an alternative therapeutic approach.

We performed a national retrospective study of patients with relapsing pediatric brain tumors treated according to the MEMMAT or MEMMAT-like regimen from 2010 to 2022. Treatment consisted of daily oral thalidomide, fenofibrate, and celecoxib, and alternating 21-day cycles of metronomic etoposide and cyclophosphamide associated with bevacizumab and intraventricular chemotherapy.

Forty-one patients were included. The most frequent malignancies were medulloblastoma (22) and ATRT (8). Overall, the best responses were CR in eight patients (20%), PR in three patients (7%), and SD in three patients (7%), for a clinical benefit rate of 34%. The median overall survival was 26 months (IC95% = 12.4–42.7), and median EFS was 9.7 months (IC95% = 6.0–18.6). The most frequent grade ¾ toxicities were hematological. Dose had to be adjusted in 27% of the cases. There was no statistical difference in outcome between full or modified MEMMAT. The best setting seems to be when MEMMAT is used as a maintenance and at first relapse.

Conclusions: The metronomic MEMMAT combination can lead to sustained control of relapsed high-risk pediatric brain tumors.

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