Second Line Chemotherapy
Phase II weekly Vinblastine

This was the second chemotherapy regimen Eleanor faced. She began this 52 week protocol on 23rd May 2018. Another portacath was inserted in to her body by surgical procedure on the 17th May 2018

Vinblastine is blood count dependent prior to treatment each week, as follows…

FBC (Full Blood Count) checked weekly 24 – 48 hours pre chemotherapy.

  • If Neutrophils more than 0.75 & Platelets more than 100 – continue with 6mg/m2 dose.
  • If Neutrophils less than 0.75 but more than 0.5 & Platelets less than 75 but more than 50 – give 4mg/m2 dose.
  • If Neutrophils less than 0.5 and / or Platelets less than 50 – omit dose & delay until count recovery.

Treatment 01 – 23.05.18 – Vinblastine 4.7mg
Treatment 02 – 30.05.18 – Vinblastine 4.7mg
Treatment 03 – 06.06.18 – Vinblastine 4.7mg
Treatment 04 – 13.06.18 – Vinblastine 3.2mg (reduced dosage because neutrophil count of 0.7)

Postponed treatment 05 – 20.06.18 (postponed dosage because neutrophil count of 0.4)

Treatment 05 – 27.06.18 – Vinblastine 4.7mg
Treatment 06 – 04.07.18 – Vinblastine 4.7mg
Treatment 07 – 11.07.18 – Vinblastine 4.7mg

Postponed treatment 08 – 18.07.18 (skipped dosage because low platelet count of 27). At this stage Eleanor required a platelet transfusion to bring her platelets back up to a safe level, which was also good enough for treatment to continue.

Treatment 08 – 25.07.18 – Vinblastine 4.7mg
Treatment 09 – 01.08.18 – Vinblastine 4.7mg
Treatment 10 – 08.08.18 – Vinblastine 4.7mg
Treatment 11 – 15.08.18 – Vinblastine 3.2mg (reduced dosage because neutrophil count of 0.6)
Treatment 12 – 22.08.18 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.6)
Treatment 13 – 29.08.18 – Vinblastine 4.7mg

Dosages increased due to body weight/height recalculation…

Treatment 14 – 05.09.18 – Vinblastine 4.9mg
Treatment 15 – 12.09.18 – Vinblastine 4.9mg
Treatment 16 – 19.09.18 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.5)
Treatment 17 – 26.09.18 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.6)
Treatment 18 – 03.10.18 – Vinblastine 4.9mg
Treatment 19 – 10.10.18 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.7)
Treatment 20 – 17.10.18 – Vinblastine 4.9mg
Treatment 21 – 24.10.18 – Vinblastine 4.9mg
Treatment 22 – 31.10.18 – Vinblastine 4.9mg
Treatment 23 – 07.11.18 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.6)
Treatment 24 – 14.11.18 – Vinblastine 4.9mg
Treatment 25 – 21.11.18 – Vinblastine 4.9mg
Treatment 26 – 28.11.18 – Vinblastine 4.9mg
Treatment 27 – 05.11.18 – Vinblastine 4.9mg
Treatment 28 – 12.12.18 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.7)
Treatment 29 – 19.12.18 – Vinblastine 4.9mg
Treatment 30 – 24.12.18 – Vinblastine 4.9mg
Treatment 31 – 02.01.19 – Vinblastine 4.9mg
Treatment 32 – 09.01.19 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.6)
Treatment 33 – 16.01.19 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.5)
Treatment 34 – 23.01.19 – Vinblastine 4.9mg
Treatment 35 – 30.01.19 – Vinblastine 4.9mg
Treatment 36 – 06.02.19 – Vinblastine 4.9mg
Treatment 37 – 13.02.19 – Vinblastine 3.3mg (reduced dosage because neutrophil count of 0.6)
Treatment 38 – 20.02.19 – Vinblastine 4.9mg

Dosages increased due to body weight/height recalculation…

Treatment 39 – 27.02.19 – Vinblastine 5.1mg
Treatment 40 – 06.03.19 – Vinblastine 5.1mg
Treatment 41 – 13.03.19 – Vinblastine 5.1mg
Treatment 42 – 20.03.19 – Vinblastine 3.4mg (reduced dosage because neutrophil count of 0.7)
Treatment 43 – 27.03.19 – Vinblastine 3.4mg (reduced dosage because neutrophil count of 0.6)
Treatment 44 – 03.04.19 – Vinblastine 5.1mg
Treatment 45 – 10.04.19 – Vinblastine 5.1mg
Treatment 46 – 17.04.19 – Vinblastine 3.4mg (reduced dosage because neutrophil count of 0.7)
Treatment 47 – 24.04.19 – Vinblastine 3.4mg (reduced dosage because neutrophil count of 0.6)
Treatment 48 – 01.05.19 – Vinblastine 3.4mg (reduced dosage because neutrophil count of 0.7)

Dosages increased due to body weight/height recalculation…

Treatment 49 – 08.05.19 – Vinblastine 5.2mg
Treatment 50 – 15.05.19 – Vinblastine 3.5mg (reduced dosage because neutrophil count of 0.7)
Treatment 51 – 22.05.19 – Vinblastine 5.2mg
Treatment 52 – 29.05.19 – Vinblastine 3.5mg (reduced dosage because neutrophil count of 0.6)

Below are the kind of efficacy studies that have been carried out. This demonstrates what we face when learning about the usefulness of toxins Eleanor has had pumped in to her little body….

Purpose: Vinblastine monotherapy has shown promising activity and a low-toxicity profile in patients with pediatric low-grade glioma (PLGG) who experienced treatment failure after initial treatment with chemotherapy and/or radiation. The aim of this study was to assess the activity of vinblastine in therapy-naïve children. Patients and methods: Patients < 18 years old with unresectable and/or progressive therapy-naïve PLGG were eligible. Vinblastine was administered once per week at a dose of 6 mg/m(2) intravenously over a period of 70 weeks. Vision, quality of life, neurofibromatosis type 1 (NF1) status, and BRAF mutation/fusion status were also determined and correlated with outcome. Results: Fifty-four patients were enrolled onto the study, with a median age of 8 years (range, 0.7 to 17.2 years). Most patients had chiasmatic/hypothalamic tumors (55.5%), and 13 patients (24.1%) had NF1. The most common histology was pilocytic astrocytoma (46.3%). Seventeen patients were diagnosed using radiologic criteria alone. Best response to chemotherapy was centrally reviewed with a response rate (complete, partial, or minor response) of 25.9%. Disease stabilization (complete, partial, or minor response or stable disease) was achieved in 47 patients (87.0%). Visual improvement was observed in 20% of patients with optic pathway glioma. Five-year overall survival and progression-free survival (PFS) rates were 94.4% (95% CI, 88.5% to 100%) and 53.2% (95% CI, 41.3% to 68.5%), respectively, for the entire cohort. Patients with NF1 had a significantly better PFS (85.1%; 95% CI, 68.0% to 100%) when compared with patients without NF1 (42.0%; 95% CI, 29.1% to 60.7%; P = .012). Age< 3 years or > 10 years was not associated with poor outcome. Treatment was well tolerated, and quality of life was not affected during treatment. In this trial, there was no correlation between BRAF alterations and outcome. Conclusion: Vinblastine administered once per week is well tolerated in children with treatment naïve PLGG. Overall survival and PFS are comparable to current therapies, with a favorable toxicity profile and a maintained quality of life.

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