Temozolomide, a new alkylating agent with the ability to cross an intact blood brain barrier and a favorable toxicity profile, has recently been shown to be active in patients with high-grade astrocytic gliomas (Yung et al. 1999). The objective of this study was to determine the response rate and time to progression after temozolomide chemotherapy in a series of patients with recurrent/progressive primary brain tumors other than high-grade gliomas. Since 1998, 36 patients with recurrent/progressive primary brain tumors other than glioblastomas and anaplastic astrocytomas, who had received prior surgery, radiotherapy and first-line PCV chemotherapy, have been enrolled. All tumors showed contrast enhancement on MRI. Initial histology was: anaplastic oligodendroglioma (AO) in 10, oligodendroglioma (O) or oligoastrocytoma (OA) in 11, astrocytoma (A) in 8, pilocytic astrocytoma (PA) in 2, ependymoma (E) in 3 (one anaplastic), medulloblastoma and germinoma in 1. Treatment consisted of oral temozolomide 150-200 mg/m2 daily on days 1-5 in cycles of 28 days. A 50% decrease in the contrast-enhancing area was defined as partial response. Results. A median of 5 cycles of temozolomide were administered (range 2-12). Responses were as follows: AO (10 patients): 3 PR (30%), 4 SD (40%) and 3 PD (30%), with a median TTP of 4 months; O and OA (11 patients): 2 PR (18%), 7 SD (64%), including 2 minor responses, 2 PD (18%), with a median TTP of 8 months; and A (8 patients): 2 PR (25%), 4 SD (50%), 2 PD (25%), with a median TTP of 6 months. The patients with pilocytic astrocytoma (2) displayed 1 SD (TTP 6 months) and 1 PD. The patients with ependymoma (3) displayed 1 PR and 2 SD (TTP 6+ months). The patients with medulloblastoma and germinoma had a PR (TTP 6+ months) and a SD (TTP 4+ months), respectively. These preliminary results suggest that temozolomide may be active in the treatment of patients with recurrent/progressive anaplastic oligodendroglioma, oligodendroglioma, oligoastrocytoma, astrocytoma, ependymoma and medulloblastoma. Patients unresponsive to PCV may respond to temozolomide.
Temozolomide in primary malignant brain tumors
Ruda R.;Nobile M.;Soffietti R.Last
2000-01-01
Abstract
Temozolomide, a new alkylating agent with the ability to cross an intact blood brain barrier and a favorable toxicity profile, has recently been shown to be active in patients with high-grade astrocytic gliomas (Yung et al. 1999). The objective of this study was to determine the response rate and time to progression after temozolomide chemotherapy in a series of patients with recurrent/progressive primary brain tumors other than high-grade gliomas. Since 1998, 36 patients with recurrent/progressive primary brain tumors other than glioblastomas and anaplastic astrocytomas, who had received prior surgery, radiotherapy and first-line PCV chemotherapy, have been enrolled. All tumors showed contrast enhancement on MRI. Initial histology was: anaplastic oligodendroglioma (AO) in 10, oligodendroglioma (O) or oligoastrocytoma (OA) in 11, astrocytoma (A) in 8, pilocytic astrocytoma (PA) in 2, ependymoma (E) in 3 (one anaplastic), medulloblastoma and germinoma in 1. Treatment consisted of oral temozolomide 150-200 mg/m2 daily on days 1-5 in cycles of 28 days. A 50% decrease in the contrast-enhancing area was defined as partial response. Results. A median of 5 cycles of temozolomide were administered (range 2-12). Responses were as follows: AO (10 patients): 3 PR (30%), 4 SD (40%) and 3 PD (30%), with a median TTP of 4 months; O and OA (11 patients): 2 PR (18%), 7 SD (64%), including 2 minor responses, 2 PD (18%), with a median TTP of 8 months; and A (8 patients): 2 PR (25%), 4 SD (50%), 2 PD (25%), with a median TTP of 6 months. The patients with pilocytic astrocytoma (2) displayed 1 SD (TTP 6 months) and 1 PD. The patients with ependymoma (3) displayed 1 PR and 2 SD (TTP 6+ months). The patients with medulloblastoma and germinoma had a PR (TTP 6+ months) and a SD (TTP 4+ months), respectively. These preliminary results suggest that temozolomide may be active in the treatment of patients with recurrent/progressive anaplastic oligodendroglioma, oligodendroglioma, oligoastrocytoma, astrocytoma, ependymoma and medulloblastoma. Patients unresponsive to PCV may respond to temozolomide.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.