A multi-center phase Ib study of oxaliplatin (NSC#266046) in combination with fluorouracil and leucovorin in pediatric patients with advanced solid tumors.

BACKGROUND: Platinum agents have been used for a variety of cancers, including pivotal use in pediatric tumors for many years. Oxaliplatin, a third generation platinum, has a different side effect profile and may provide improved activity in pediatric cancers. PROCEDURE: Patients 21 years or younger with progressive or refractory malignant solid tumors, including tumors of the central nervous system were enrolled on this multi-center open label, non-randomized Phase 1 dose escalation study. The study used a standard 3 + 3 dose escalation design with 2 dose levels (85 and 100 mg/m(2) ) with an expansion cohort of 15 additional patients at the recommended dose. Patients received oxaliplatin at the assigned dose level and 5-fluorouracil (5-FU) bolus 400 mg/m(2) followed by a 46-hour 5-FU infusion of 2,400 mg/m(2) every 14 days. The leucovorin dose was fixed at 400 mg/m(2) for all cohorts. RESULTS: Thirty-one evaluable patients were enrolled, 8 at 85 mg/m(2) and 23 at 100 mg/m(2) for a total of 121 courses. The median age was 12 years (range 2-19 years). The main toxicities were hematologic, primarily neutrophils and platelets. The most common non-hematologic toxicities were gastrointestinal. Stable disease was noted in 11 patients (54% of evaluable patients) and 1 confirmed partial response in a patient with osteosarcoma. CONCLUSIONS: The maximum planned dose of oxaliplatin at 100 mg/m(2) per dose in combination with 5-FU and leucovorin was safe and well tolerated and in this patient population. This combination demonstrated modest activity in patients with refractory or relapsed solid tumor and warrants further study. Pediatr Blood Cancer 2013;60:230-236. © 2012 Wiley Periodicals, Inc.

Collaborative approaches to increasing family support for HIV positive youth.

Family therapists working in medical contexts often struggle to find a common language for communication with medical staff about the importance of family support. HIV positive youth are a group who have particular need for family support to help improve medication adherence, promote more open and positive communication, and decrease substance use and risk behaviors. In this paper, the authors retrospectively examined the levels of family support in a sample of 50 North American urban minority youth coping with HIV in an HIV/AIDs pediatric clinic from 2003 to 2007 at 2 time points (pre- and postdiagnosis) and began developing a clinician-rated family support tool. The authors highlight the use of a common clinician-rated family support tool for medical and mental health staff to discuss patients and their families. Results suggest that the family support youth were receiving fell between mixed and unsupportive levels both at pre- and postdiagnosis. Through the use of a case example the authors elaborate on how this family support tool aided in building a collaborative relationship with a focus on garnering family support for youth coping with the diagnosis of HIV.