title: Mechlorethamine, vincristine, and procarbazine chemotherapy for recurrent high-grade glioma in adults: a phase II study.
abstract: We undertook a phase II study of combination chemotherapy with mechlorethamine (nitrogen mustard) 6 mg/m2 intravenously day 1 and day 8, vincristine 2 mg intravenously day 1 and day 8, and procarbazine 100 mg/m2 orally days 1 through 14 (MOP) in adults with recurrent high-grade glioma. There were 31 patients entered and 27 patients assessable for response. The median age was 49 years old. All patients had prior maximal radiotherapy, and eight had previous chemotherapy. Responses were determined based on clinical and computed tomographic (CT) scan/magnetic resonance imaging (MRI) criteria. The response rate (partial response [PR] plus objective qualitative response [OQR] plus complete response [CR]) was 52% with one CR. The response rate was higher in patients with anaplastic astrocytoma as compared with glioblastoma multiforme (P less than .05). The median duration of response was 42 weeks. Median survival for all assessable patients was 30 weeks, and for responders, it was 60 weeks. Response was correlated with ability to decrease dexamethasone doses and improved performance status. Toxicity was mainly hematologic with leukopenia being common. There was one treatment-related death from listeria meningitis, and two patients developed Pneumocystis carinii pneumonia. There were three episodes of neutropenic fever. We conclude that MOP is active and merits further investigation in adult high-grade glioma.
authors.affiliation: Department of Medicine, State University of New York Health Science Center, Syracuse 13210.
authors.forename: T
authors.initials: T
authors.lastname: Coyle
authors.forename: J
authors.initials: J
authors.lastname: Baptista
authors.forename: J
authors.initials: J
authors.lastname: Winfield
authors.forename: K
authors.initials: K
authors.lastname: Clark
authors.forename: B
authors.initials: B
authors.lastname: Poiesz
authors.forename: J
authors.initials: J
authors.lastname: Kirshner
authors.forename: A
authors.initials: A
authors.lastname: Scalzo
authors.forename: N
authors.initials: N
authors.lastname: Newman-Palmer
authors.forename: R
authors.initials: R
authors.lastname: King
authors.forename: S
authors.initials: S
authors.lastname: Graziano
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine