Dose Intensification in Pediatric Malignancies

The Seventh Forbeck Forum addressed the rationale and potential strategies for increasing dose of drug administered per unit time in treating pediatric patients.  Evidence accumulating from an analysis of trials in adults, and to a lesser extent children, suggest that greater success is achieved by using the maximum tolerated dose intensity of chemotherapy.  There now exists unprecedented opportunities for increasing dose intensity through the use of bone marrow protection or rescue strategies.  The challenge facing the pediatric oncologist is to develop the optimal high-dose regimens, factoring in considerations of patient tolerance, optimally effective combinations of agents, and the schedule of drug administration.  In order to consider this subject, experts on all phases of dose intensification were assembled, representing the best research in cancer drug testing, bone marrow rescue, treatment of infectious complications of chemotherapy, and the design of regimens that overcome drug resistance.