Nitrosourea-based chemotherapy for low grade gliomas failing initial treatment with temozolomide.
There is a growing evidence of using Temozolomide as upfront therapy for progressive low grade gliomas. No data exist on the efficacy of nitrosoureas as an alternative to radiotherapy in those patients who progress after Temozolomide. We retrospectively reviewed 30 patients with median age of 46 years. Twenty-one patients had pure oligodendrogliomas. Thirteen patients had a non-enhancing tumor at progression after Temozolomide. The chromosomes 1p/19q were co-deleted in 5 cases and retained in 10 cases. Response rate was 10% (3 minor responses achieved in non-enhancing tumors). Tolerance was acceptable (17% grade III and IV myelosupression). Median PFS was 6.5 months. Median OS from start of salvage treatment was 23.4 months. Tumors without contrast enhancement demonstrated a better prognosis than those with contrast enhancement both in term of PFS (P = 0.0003) and OS (P = 0.0006). Chromosomes 1p/19q codeletion was not predictive for objective response to salvage treatment but correlated with a better PFS (P = 0.02). In conclusion, salvage NU chemotherapy provide disappointing results in TMZ-pretreated low grade gliomas (LGG), which should be treated in priority by conventional radiotherapy especially in LGG that display contrast enhancement at progression.
Kaloshi
Gentian
G
AP-HP, Université Pierre et Marie Curie UPMC, Service de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Sierra del Rio
Monica
M
Ducray
François
F
Psimaras
Dimitri
D
Idbaih
Ahmed
A
Laigle-Donadey
Florence
F
Taillibert
Sophie
S
Houillier
Caroline
C
Dehais
Caroline
C
Omuro
Antonio
A
Sanson
Marc
M
Delattre
Jean-Yves
JY
Hoang-Xuan
Khe
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy*; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077204:Temozolomide; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D009607:Nitrosourea Compounds; D003606:Dacarbazine; D000077204:Temozolomide
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