title: Phase II study of temozolomide and cisplatin as primary treatment prior to radiotherapy in newly diagnosed glioblastoma multiforme patients with measurable disease. A study of the Spanish Medical Neuro-Oncology Group (GENOM).
abstract: This phase II study evaluates the activity of temozolomide and cisplatin administered before radiation therapy in newly diagnosed glioblastoma multiforme patients, in terms of response, time to progression and survival.
  
  
  METHODS
  Forty patients with measurable disease after surgery, a Karnofsky status > 60, and Barthel Index > 10 were included. They were treated with three cycles of temozolomide 200 mg/m2/day for 5 days and cisplatin 100 mg/m2 on day 1. Conventional focal radiation therapy to 60 Gy was administered after response evaluation.
  
  
  RESULTS
  Three patients were not evaluable for central reviewed response but all 40 were evaluable for toxicity, time to progression and survival. Objective responses by Macdonald criteria on an intent to treat basis were 45% including complete response in three patients (7.5%), and partial response in 15 patients (37.5%). Responses were seen in biopsy-only patients (33.4%) as well as in partial surgery patients (52%). Median survival for all patients was 12.5 months. Biopsy-only patients had a median survival of 12.8 months. Grade 3 to 4 neutropenia was the most important toxicity, and occurred in 37.5% of patients. A delay in 18.2% and a dose reduction in 9.6% of cycles were necessary due to myelosuppression on day 28. Two patients had neutropenic fever resulting in one treatment-related death. Eighty-two percent of patients received radiotherapy.
  
  
  CONCLUSIONS
  This regimen has significant activity, as it induces objective responses even in biopsy-only patients, appearing to improve their median survival. A better combination schedule is needed to improve the toxicity profile.
authors.affiliation: Medical Oncology Services, Institut Catala d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. cbalana@ns.hugtip.scs.es
authors.forename: Carmen
authors.initials: C
authors.lastname: Balaña
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Pousa
authors.forename: Alfonso
authors.initials: A
authors.lastname: Berrocal
authors.forename: Ricardo
authors.initials: R
authors.lastname: Yaya-Tur
authors.forename: Ana
authors.initials: A
authors.lastname: Herrero
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: García
authors.forename: Javier
authors.initials: J
authors.lastname: Martín-Broto
authors.forename: Manuel
authors.initials: M
authors.lastname: Benavides
authors.forename: Miguel
authors.initials: M
authors.lastname: Cerdá-Nicolás
authors.forename: Rosa
authors.initials: R
authors.lastname: Ballester
authors.forename: Josep
authors.initials: J
authors.lastname: Balart
authors.forename: Jaume
authors.initials: J
authors.lastname: Capellades
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality* / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy; D016019:Survival Analysis; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D003606:Dacarbazine; D002945:Cisplatin; D000077204:Temozolomide