Ifosfamide, Carboplatin, and Etoposide as Neoadjuvant Chemotherapy in Patients With Neurofibromatosis Type I-related Malignant Peripheral Nerve Sheath Tumors.

Background/aim: The role of chemotherapy for malignant peripheral nerve sheath tumors (MPNSTs) remains controversial, particularly in neurofibromatosis type 1 (NF1)-related MPNST (NF1-MPNST). This study aimed to assess the clinical outcomes of patients with NF1-MPNST who underwent curative treatment comprising neoadjuvant chemotherapy followed by wide resection.

Patients and methods: We retrospectively analyzed data from patients with NF1-MPNST who received preoperative chemotherapy. The regimen was ifosfamide 1.5 g/m² on days 1-3, carboplatin 400 mg/m² on day 3, and etoposide 100 mg/m² on days 1-3 (ICE). Radiographic response, overall survival, and toxicity were evaluated.

Results: We analyzed data from 12 patients treated between 2005 and 2023. All patients received two to four courses of ICE without concomitant radiation therapy, with a median 20.4% (range=-14-63%) reduction in tumor size. According to the RECIST criteria, four patients had partial responses and eight had stable disease. The 5-year overall survival rate was 81.8%. The survival rate of patients with a partial response was 100%. Toxicities included myelosuppression, nausea, and general fatigue. Three patients received platelet transfusions. Three patients discontinued neoadjuvant chemotherapy because of patient preference.

Conclusion: In this study, we achieved more favorable outcomes than those in previous studies. Neoadjuvant chemotherapy, which included the ICE regimen, not only resulted in tumor shrinkage in eight of 12 cases but also demonstrated a good prognosis when tumor shrinkage was achieved. These findings suggest that neoadjuvant chemotherapy with the ICE regimen may be a promising approach for managing NF1-MPNST.