Treatment > Cyclophosphamide  

Abstract

Newly diagnosed primary central nervous system lymphoma (PCNSL): initial report of North Central Cancer Treatment Group (NCCTG)/Eastern Cooperative Oncology Group (ECOG) protocol 93 73 51

Brian Patrick O'Neill, Judith Rich O'Fallon, Stephen S Cha, Paul J Kurtin, Bernd W Scheithauer, Paul D Brown, Thomas A Habermann, Fernando K Addo, Mark Gilbert

Mayo Clinic and Foundation, Rochester, MN; The Quain and Ramstad Clinic, Bismarck, ND; M.D. Anderson Cancer Center, Houston, TX

The optimal treatment for PCNSL is still unsettled.
Current therapies extend survival but do not increase the cure rate.
Furthermore, neurotoxicity remains a formidable concern.

Methods. We conducted a Phase II trial in newly diagnosed biopsy-proven PCNSL to assess the efficacy and toxicity of combined cyclophosphamide, adriamycin, vincristine, dexamethasone, BCNU, cytosine arabinoside and methotrexate followed by 30.6 Gy whole brain irradiation (WBRT) if complete response (CR) or 50.4 Gy WBRT if less than CR, both given at 1.8 Gy daily fractions.
The primary efficacy endpoint was one-year survival.
Patient entry was capped at age 70 years.

Results. All 36 enrolled patients (19 men, 17 women) were eligible.
Their median age was 60.5 years (range 34-69 years).
33 patients (94%) had large cell histology; 30 (83%) had baseline ECOG performance scores of 0-1; 15 had measurable disease, and 19 had evaluable disease. Currently, 35 patients are eligible for response; 21 patients have progressed, and 23 have died.
Of the 13 living patients , 7 are off study.
Median survival is 66.3 weeks, and median time to progression is 46.4 weeks.
Best response was CR in 9 patients and immediate progression in 7. 4 patients had grade 4 toxicity including 1 with life threatening sepsis syndrome.

Conclusions. This regimen did not improve the survival of our PCNSL patients.
Further research into causation is needed in order to develop pathogenesis-based prevention and treatment strategies.

© Copyright 2002 American Society of Clinical Oncology