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Malignant Pheochromocytoma: Effective Treatment with a Combination of Cyclophosphamide, Vincristine, and Dacarbazine

Steven D. Averbuch, MD; Caryn S. Steakley, RN; Robert C. Young, MD; Edward P. Gelmann, MD; David S. Goldstein, MD, PhD; Robin Stull, BS; and Harry R. Keiser, MD
[+] Article, Author, and Disclosure Information

Presented in part 19 May 1987 at the Twenty-Third Annual Meeting of the American Society of Clinical Oncology, Atlanta, Georgia.

Requests for Reprints: Steven D. Averbuch, MD, Department of Neoplastic Diseases, Box 1129, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029.

Current Author Addresses: Dr. Averbuch: Department of Neoplastic Diseases, Box 1129, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029.

Ms. Steakley and Dr. Gelmann: Medicine Branch, National Cancer Institute, Building 10, Room 12N226, National Institutes of Health, Bethesda, MD 20892.

Dr. Young: CCOP, National Cancer Institute, Blair Building, Room 732, Bethesda, MD 20892-4200.

Drs. Goldstein, Stull, and Keiser: Hypertension-Endocrine Branch, National Heart, Lung, and Blood Institute, Building 10, Room 1C103, National Institutes of Health, Bethesda, MD 20892.

Ann Intern Med. 1988;109(4):267-273. doi:10.7326/0003-4819-109-4-267
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Study Objective: To determine the efficacy and toxicity of combination chemotherapy in patients with advanced, malignant pheochromocytoma.

Design: Nonrandomized, single-arm trial.

Setting: Governmental medical referral center.

Patients: Fourteen patients with malignant pheochromocytoma confirmed by histologic tests. All patients had metastatic disease and elevated urinary catecholamine secretion.

Interventions: After optimization of antihypertensive therapy, patients received cyclophosphamide, 750 mg/m2 body surface area on day 1; vincristine, 1.4 mg/m2 on day 1, and dacarbazine, 600 mg/m2 on days 1 and 2, every 21 days.

Measurements and Main Results: Combination chemotherapy with cyclophosphamide, vincristine, and dacarbazine produced a complete and partial response rate of 57% (median duration, 21 months; range, 7 to more than 34). Complete and partial biochemical responses were seen in 79% of patients (median duration, more than 22 months; range, 6 to more than 35). All responding patients had objective improvement in performance status and blood pressure. Toxicity included expected hematologic, neurologic, and gastrointestinal effects of chemotherapy without serious sequelae. There were four minor hypotensive episodes and one minor hypertensive episode.

Conclusions: Combination chemotherapy with cyclophosphamide, vincristine, and dacarbazine is effective for advanced malignant pheochromocytoma. Urinary catecholamines are useful to ascertain biochemical response to therapy.





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