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Combined
immunochemotherapy with reduced dose whole brain radiotherapy (WBRT) for newly
diagnosed patients with primary CNS lymphoma (PCNSL)
F. G. El Kamar, L. M. Deangelis, J. Yahalom, D. D. Correa, B. W. Grant, R. V.
Larocca, J. J. Raizer, D. Schiff, L. E. Abrey
Memorial Sloan-Kettering Cancer Center, New York, NY; University
of Vermont, Burlington, VT; Kentuckiana Cancer Inst PLLC, Louisville, KY;
Northwestern University, Feinberg School of Medicine, Chicago, IL; University of
Virginia Medical Ctr, Dept of Neurology, Charlottesville, VA
Background. High-dose methotrexate based
chemotherapy combined with WBRT for patients (pts) with newly diagnosed PCNSL
has been shown to improve disease control and overall survival.
However, disease recurrence is common and treatment-related neurotoxicity is an
increasingly recognized complication.
We hypothesized that the addition of Rituximab to Methotrexate, Procarbazine and
Vincristine (MPV) might improve overall survival and disease control, similar to
that seen with R-CHOP.
Also decreasing the dose of WBRT in patients who achieve an initial CR may
diminish the risk of treatment related neurotoxicity.
This study was designed to determine the safety and efficacy of combined
immunochemotherapy followed by reduced dose WBRT.
Methods.
Seventeen pts (7 men; median
KPS 80%) of a planned 30 pts have been enrolled from August 2002 to September
2003.
14 (7M) were treated, 3 were not eligible.
Each pt received 500 mg/mē of rituximab on day 1, MTX 3.5 gm/mē with VCR 1.4
mg/mē on day 2.
Procarbazine 100 mg/mē/d was given for 7 days.
Pts achieving CR after 5-7 cycles received dose reduced WBRT (2340 cGy) while
patients with less than a CR received WBRT (4500 cGy).
All pts received 2 cycles of ara-c 3gm/mē after WBRT.
All pts are followed with prospective neuropsychological evaluations.
CSF + serum levels of rituximab are being assayed in pts with an Ommaya
reservoir.
Results.
Twelve of the 14 treated pts
have been assessed for response.
Eight (67%) had a CR, 3 (25%) a PR (ORR of 92%) and one (8%) progressed.
Eight pts received 2340cGy of WBRT and 3 received 4500 cGy.
Three pts were taken off study, 1 for PD and 2 for toxicity (grade 3
nephrotoxicity and death from neutropenic sepsis in one pt each).
Other toxicities are reported in table1.
Conclusions. The safety and efficacy of
R-MPV is comparable to MPV.
Further investigation of this regimen in PCNSL is warranted.
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Table 1
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Toxicity
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Grade3
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Grade4
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Anemia
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2(14%)
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0
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Creatinine
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1(7%)
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0
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Granulocytopenia
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2(14%)
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2(14%)
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Thrombocytopenia
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3(21%)
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0
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Nausea
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1(7%)
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0
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Vomiting
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1(7%)
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0
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Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-001097,00.asp
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