Article
Continuing first-line Temozolomide treatment far beyond 6 cycles in patients with residual malignant glioma
Search Medline for
Authors
Published: | May 21, 2013 |
---|
Outline
Text
Objective: The current standard of care for newly diagnosed glioblastoma is radiotherapy with concomitant temozolomide followed by 6 adjuvant cycles of temozolomide. In special treatment settings of patients with malignant glioma a prolonged administration of TMZ was performed when contrast enhancing tumor was persisting at the end of cycle number 6 of adjuvant temozolomide.
The aim of this analysis was to determine overall survival, progression-free survival and hematoxicity under prolonged adjuvant temozolomide treatment for this subpopulation. Furthermore to investigate if extended temozolomide treatment may lead to late regression of persisting tumor.
Method: Clinical data of 982 malignant glioma patients from two different institutions who underwent tumor resection in 1998–2011 were collected and evaluated by using an electronic database and patient files. In a subpopulation of 32 patients (16 male, 16 female, mean age 69 years, range 28–70 years) with malignant glioma WHO°III (n=12) and WHO°IV (n=20) first-line adjuvant temozolomide 150–200mg/day 1–5/28 was continuously administered for 10 and more cycles if contrast enhancing lesions persisted in serial MRI controls after completion of 6 adjuvant cycles. KPS, hematoxicity, progression free- and overall survival were evaluated in this special subgroup.
Results: Hematoxicity data were available for all 32 patients and evaluated by CTCAE guidelines. Extended adjuvant therapy in these patients was not associated with increased toxicity. The mean number of administered cycles was 19.4 (range 10–46 cycles). The median KPS pre- and postoperatively was 70%. By a mean follow-up interval of 46 months for survivors, 20 patients of 32 showed MRI-confirmed tumor progression during extended temozolomide treatment. Median PFS was 31.7 (range 3.5–75.6) months, median OS 39.5 months (range 15.6–78.1).
Conclusions: These data suggest that extended adjuvant temozolomide treatment (at least 10 cycles in this subgroup) for residual malignant glioma was well tolerated and facilitated disease control for remarkable periods of time. For patients with subtotally resected or biopsied tumors prolonged administration of TMZ could contribute to a certain stabilization of the tumor.