title: ACNU-based chemotherapy for recurrent glioma in the temozolomide era.
abstract: No standard of care for patients with recurrent glioblastoma has been defined since temozolomide has become the treatment of choice for patients with newly diagnosed glioblastoma. This has renewed interest in the use of nitrosourea-based regimens for patients with progressive or recurrent disease. The most commonly used regimens are carmustine (BCNU) monotherapy or lomustine (CCNU) combined with procarbazine and vincristine (PCV). Here we report our institutional experience with nimustine (ACNU) alone (n=14) or in combination with other agents (n=18) in 32 patients with glioblastoma treated previously with temozolomide. There were no complete and two partial responses. The progression-free survival (PFS) rate at 6 months was 20% and the survival rate at 12 months 26%. Grade III or IV hematological toxicity was observed in 50% of all patients and led to interruption of treatment in 13% of patients. Non-hematological toxicity was moderate to severe and led to interruption of treatment in 9% of patients. Thus, in this cohort of patients pretreated with temozolomide, ACNU failed to induce a substantial stabilization of disease in recurrent glioblastoma, but caused a notable hematotoxicity. This study does not commend ACNU as a therapy of first choice for patients with recurrent glioblastomas pretreated with temozolomide.
authors.affiliation: Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Medical School, Tubingen, Germany. caroline.happold@usz.ch
authors.forename: Caroline
authors.initials: C
authors.lastname: Happold
authors.forename: Patrick
authors.initials: P
authors.lastname: Roth
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wick
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Steinbach
authors.forename: Michael
authors.initials: M
authors.lastname: Linnebank
authors.forename: Michael
authors.initials: M
authors.lastname: Weller
authors.forename: Günter
authors.initials: G
authors.lastname: Eisele
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D015376:Nimustine / Q000627:therapeutic use*; D000077204:Temozolomide
chemical_list: D000970:Antineoplastic Agents; D015376:Nimustine; D003606:Dacarbazine; D000077204:Temozolomide