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Survival
analysis for patients with primary brain tumors treated with temozolomide
B.
E. Lally, J. Lacy, J. M. Piepmeier, J. M. Baehring, D. B. Fischer, J. P. S.
Knisely
Yale
University - School of Medicine, New Haven, CT
Purpose.
Temozolomide(TEM) is a novel alkylating agent that has shown promising results
when utilized in management of high-grade gliomas.
We retrospectively reviewed our experience with TEM to determine if a survival
benefit was associated with its use in patients with anaplastic astrocytomas
(AA) and glioblastoma multiforme (GBM).
Methods.
Between 3/1999 and 8/2002, 59 consecutive adult patients with high-grade gliomas
were treated at our institution with radiotherapy.
Twenty patients started treatment with adjuvant TEM given either concurrently
with radiotherapy (75 mg/m^2 every day) and post radiotherapy (200 mg/m^2 daily
for 5 days, q4 weeks), or post radiotherapy alone (200 mg/m^2 daily for 5 days,
q4 weeks).
Thirty-five patients started treatment with adjuvant BCNU or PCV chemotherapy
and 4 patients did not receive any adjuvant chemotherapy.
Of these patients, 20 never received TEM while 19 subsequently were treated with
TEM at the time of progression (200 mg/m^2 daily for 5 days, q4 weeks, but
reduced to 150 mg/m^2 if prior nitrosourea therapy given).
The primary endpoint was overall survival.
Results.
Of the patients who received TEM as an adjuvant therapy or for progression (n =
39), 29 patients had GBM and 10 had AA.
The median age of patients receiving TEM was 54 years (range 24-80 years).
Of the patients who did not receive TEM (n=20), 13 had GBM and 7 had AA.
The median age of patients not receiving TEM was 56 years (range 24-72 years).
One of the patients who originally did not receive adjuvant chemotherapy was
treated with TEM for progression.
The median survival for patients receiving TEM, either as an adjuvant therapy or
for progression, was 17.8 months, while the median survival for patients not
receiving TEM was 6.4 months (p=0.01).
Conclusions.
This retrospective analysis suggests that the use of TEM in the management of
patients with high-grade gliomas may be associated with an increase in survival.
Phase III trials are necessary to verify this observation.
©
Copyright 2003 American Society of Clinical Oncology All rights reserved
worldwide
Source: http://www.asco.org/ac/1,1003,_12-002489-00_18-002003-00_19-00101103-00_29-00A,00.asp?cat=CNS+Tumors&parent=
Central+Nervous+System+Tumors&returnpid=2325&SubCat_ID=4 |
