title: Treatment of recurrent malignant gliomas with fotemustine monotherapy: impact of dose and correlation with MGMT promoter methylation.
abstract: BACKGROUND
  In recurrent malignant gliomas (MGs), a high rate of haematological toxicity is observed with the use of fotemustine at the conventional schedule (100 mg/m(2) weekly for 3 consecutive weeks followed by triweekly administration after a 5-week rest period). Also, the impact of O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status on fotemustine activity has never been explored in the clinical setting.
  
  
  METHODS
  40 patients with recurrent pretreated MG were identified as being treated with fotemustine at doses ranging from 65 mg/m(2) to 100 mg/m(2). Patients were classified into 3 groups according to the dose of fotemustine received, from the lowest dosage received in group A, to the highest in group C. Analysis of MGMT promoter methylation in tumor tissue was successfully performed in 19 patients.
  
  
  RESULTS
  Overall, 20% of patients responded to treatment, for a disease control rate (DCR, responses plus stabilizations) of 47.5%. Groups A and B experienced a response rate of 40% and 26.5% respectively, while the corresponding value for group C was 10%. Out of 19 patients, MGMT promoter was found methylated in 12 cases among which a DCR of 66.5% was observed. All 7 patients with unmethylated MGMT promoter were progressive to fotemustine.
  
  
  CONCLUSIONS
  Low-dose fotemustine at 65-75 mg/m(2) (induction phase) followed by 75-85 mg/m(2) (maintenance phase) has an activity comparable to that of the conventional schedule. By determination of the MGMT promoter methylation status patients might be identified who are more likely to benefit from fotemustine chemotherapy.
authors.affiliation: Division of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy. alessandra.fabi@virgilio.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fabi
authors.forename: Giulio
authors.initials: G
authors.lastname: Metro
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Russillo
authors.forename: Antonello
authors.initials: A
authors.lastname: Vidiri
authors.forename: Carmine Maria
authors.initials: CM
authors.lastname: Carapella
authors.forename: Marta
authors.initials: M
authors.lastname: Maschio
authors.forename: Francesco
authors.initials: F
authors.lastname: Cognetti
authors.forename: Bruno
authors.initials: B
authors.lastname: Jandolo
authors.forename: Maria Alessandra
authors.initials: MA
authors.lastname: Mirri
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Stefano
authors.initials: S
authors.lastname: Telera
authors.forename: Mariantonia
authors.initials: M
authors.lastname: Carosi
authors.forename: Andrea
authors.initials: A
authors.lastname: Pace