title: Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy--results of a United Kingdom phase II trial (CNS 2007 04).
abstract: Diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis with no chemotherapy regimen so far resulting in any significant improvement over standard radiotherapy. In this trial, a prolonged regimen (21/28d) of temozolomide was studied with the aim of overcoming O(6)-methylguanine methyltransferase (MGMT) mediated resistance. Forty-three patients with a defined clinico-radiological diagnosis of DIPG received radiotherapy and concomitant temozolomide (75 mg/m(2)) after which up to 12 courses of 21d of adjuvant temozolomide (75-100mg/m(2)) were given 4 weekly. The trial used a 2-stage design and passed interim analysis. At diagnosis median age was 8 years (2-20 years), 81% had cranial nerve abnormalities, 76% ataxia and 57% long tract signs. Median Karnofsky/Lansky score was 80 (10-100). Patients received a median of three courses of adjuvant temozolomide, five received all 12 courses and seven did not start adjuvant treatment. Three patients were withdrawn from study treatment due to haematological toxicity and 10 had a dose reduction. No other significant toxicity related to temozolomide was noted. Overall survival (OS) (95% confidence interval (CI)) was 56% (40%, 69%) at 9 months, 35% (21%, 49%) at 1 year and 17% (7%, 30%) at 2 years. Median survival was 9.5 months (range 7.5-11.4 months). There were five 2-year survivors with a median age of 13.6 years at diagnosis. This trial demonstrated no survival benefit of the addition of dose dense temozolomide, to standard radiotherapy in children with classical DIPG. However, a subgroup of adolescent DIPG patients did have a prolonged survival, which needs further exploration.
authors.affiliation: Great North Childrens Hospital, Newcastle upon Tyne, United Kingdom. Electronic address: simon.bailey@ncl.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Bailey
authors.forename: A
authors.initials: A
authors.lastname: Howman
authors.forename: K
authors.initials: K
authors.lastname: Wheatley
authors.forename: D
authors.initials: D
authors.lastname: Wherton
authors.forename: N
authors.initials: N
authors.lastname: Boota
authors.forename: B
authors.initials: B
authors.lastname: Pizer
authors.forename: D
authors.initials: D
authors.lastname: Fisher
authors.forename: P
authors.initials: P
authors.lastname: Kearns
authors.forename: S
authors.initials: S
authors.lastname: Picton
authors.forename: F
authors.initials: F
authors.lastname: Saran
authors.forename: M
authors.initials: M
authors.lastname: Gibson
authors.forename: A
authors.initials: A
authors.lastname: Glaser
authors.forename: D J A
authors.initials: DJ
authors.lastname: Connolly
authors.forename: D
authors.initials: D
authors.lastname: Hargrave
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D020295:Brain Stem Neoplasms / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005910:Glioma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D011788:Quality of Life; D012074:Remission Induction; D016019:Survival Analysis; D000077204:Temozolomide; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Diffuse intrinsic pontine glioma (DIPG); Temozolomide