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Carboplatin and
etoposide (CE) chemotherapy in patients with recurrent or progressive
oligodendroglial tumors
L. Scopece, G. Cavallo, E. Palmerini, E. Franceschi, A. Paioli, F. Spagnolli,
S. Rimondini, R. Conforti, R. Degli Esposti, L. Crino
Bellaria Hospital, Bologna, Italy.
Background. Oligodendroglial tumors are
chemosensitive diseases, and the response rate (RR) with first line chemotherapy
is in the range of 40 to 70%.
Second line chemotherapy with temozolomide showed a RR of 40-60%.
However TTP with these therapies cannot be considered satisfactory and other
active treatments are necessary.
Etoposide (VP-16) is a topoisomerase IIα inhibitor which penetrates the CNS
and has activity against a variety of CNS tumors, showing a synergistic effect
with cisplatin or carboplatin, either in vitro and in vivo.
Methods. In this phase II trial primary
endpoint was to evaluate the RR following first and second line Carboplatin and
Etoposide (CE) regimen in patients with recurrent/progressive oligodendroglioma
(O2), anaplastic oligodendroglioma (O3), oligoastrocytoma (OA2) and anaplastic
oligoastrocytoma (OA3).
PFS, TTP, overall survival and toxicity were evaluated as secondary
endpoints.
Patients were treated with first or second line carboplatin AUC 5 on day 1 and
etoposide 120 mg/m2 on days 1 to 3 every 28 days.
Results. 18 pts were included in the
study (median age 45.5 yrs, range 28-65 y; median KPS 90, range 70-100; 1 O2, 1
OA2, 8 O3 and 8 OA3).
Twelve patients were treated with first line CE, and in 6 pts the treatment was
given as a second line.
All pts were evaluable for response: 1 CR (5.6%) and 5 PR (27.8%) were obtained
with a RR of 33.4%.
Eight pts (44.4%) were stable for more than two months.
At the time of analysis 14 patients had progression while 4 patients were
progression free.
The median TTP was 8 months.
The PFS at 6 and 12 months were 70.5% and 37.5% respectively; in responders
these percentages were 100% and 80%, respectively.
A total of 78 cycles of CE were administered (median 4, range 1-7).
When given in first line, CE regimen showed a RR of 41.1% (1CR and 4PR).
Toxicity was mainly hematological, with grade 3-4 neutropenia in 2 (11.1%)
pts.
Mild nausea and vomiting were common.
Conclusions. In this trial the CE
regimen has shown activity and a good toxicity profile.
Further studies with biological correlations with LOH of 1p and 19q are
warranted.
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_19-003732,00.asp
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