title: Temozolomide low-dose chemotherapy in newly diagnosed low-grade gliomas: activity, safety, and long-term follow-up.
abstract: OBJECTIVE
  To explore the efficacy and toxicity of an extended schedule of temozolomide (50 mg/mq 1 week on/1 week off) in a population of newly diagnosed low-grade gliomas (LGG).
  
  
  METHODS
  Primary endpoints were progression-free survival (PFS) at 12 and 24 months and response rate evaluated with Response Assessment in Neuro-Oncology Criteria. Secondary endpoints were clinical benefit (reduction of seizures frequency), reduction of steroid, and modifications of Karnofsky Performance Status.
  
  
  RESULTS
  From 2006 to 2009, we enrolled 14 consecutive patients with newly diagnosed LGG: 8 grade II astrocytomas, 2 oligodendroglioma, and 4 oligo-astrocytoma. Temozolomide was administered for 18 cycles (mean) per patient (range 3-24 cycles). In 57.5% (n = 8), we observed stable disease, 28.5% (n = 4) presented a minor response, and 14% (n = 2) showed progression. Five patients presented early progression during the first year of treatment and the study was stopped. A relevant clinical benefit was observed in 85% of patients (seizure control). After 6 years of follow-up, only 4 patients died. Prolonged PFS was associated with 1p-19q codeletion over 1p-19q intact (35 vs 4 months; p<0.04) and IDH1 mutation over IDH1 wild-type (36 vs 6 months; p<0.009).
  
  
  CONCLUSIONS
  The study was interrupted for the high rate of progression observed in the first 14 patients enrolled. However, our results show that an extended low dose of temozolomide presents interesting activity with objective response and clinical benefit, but does not seem to prevent progression in patients presenting unfavorable molecular prognostic factors.
authors.affiliation:  Neuro-Oncology Unit, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Villani
authors.affiliation:  Clinical Pathology Unit, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Merola
authors.affiliation:  Service of Neuroradiology, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Vidiri
authors.affiliation:  Division of Medical Oncology, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fabi
authors.affiliation:  Neuropathology Unit, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Mariantonia
authors.initials: M
authors.lastname: Carosi
authors.affiliation:  Biostatistic Unit, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.affiliation:  Division of Radiotherapy, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Marucci
authors.affiliation:  Neuro-Oncology Unit, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Maschio
authors.affiliation:  Division of Neurosurgery, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Carapella
authors.affiliation:  Neuro-Oncology Unit, "Regina Elena" National Cancer Institute, Rome - Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pace
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D001254:Astrocytoma / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D019175:DNA Methylation / Q000187:drug effects*; D015254:DNA Modification Methylases; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D015254:DNA Modification Methylases; D000077204:Temozolomide