Dose-intensity temozolomide after concurrent chemoradiotherapy in operated high-grade gliomas

• Published in: Journal of neuro-oncology Vol. 90; no. 3; pp. 315 - 319
• Main Authors: Dall’Oglio, Stefano, D’Amico, Anna, Pioli, Fabio, Gabbani, Milena, Pasini, Felice, Passarin, Maria Grazia, Talacchi, Andrea, Turazzi, Sergio, Maluta, Sergio
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.12.2008; Springer Nature B.V
• Subjects: Adult; Aged; Antineoplastic Agents, Alkylating - therapeutic use; Brain Neoplasms - classification; Brain Neoplasms - drug therapy; Brain Neoplasms - mortality; Brain Neoplasms - radiotherapy; Clinical Study - Patient Study; Dacarbazine - analogs & derivatives; Dacarbazine - therapeutic use; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Glioma - classification; Glioma - drug therapy; Glioma - mortality; Glioma - radiotherapy; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Oncology; Pneumocystis carinii; Retrospective Studies; Dose intensity; Temozolomide; Radiotherapy; High-grade gliomas
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-008-9663-9

Purpose We performed a new phase II trial enrolling patients with newly diagnosed high-grade glioma (HGG) to test the efficacy of a weekly alternating temozolomide (TMZ) schedule after surgery and concomitant chemoradiotherapy. Methods From January 2005 to January 2007, 34 patients (21 men, 13 women; age range 30–70, mean age 53) were enrolled. There were 32 glioblastoma multiforme and two anaplastic astrocytoma. Each patient after surgery received standard concurrent chemoradiotherapy. After a 4-week break, patients were then to receive 12 cycles of 1-week-on/1-week-off TMZ, with 75 mg/m 2 for the first cycle, 100 mg/m 2 for the second, 125 mg/m 2 for the third, and 150 mg/m 2 from the fourth to the 12th. Hematological toxicity was monitored every week during concomitant chemoradiotherapy and then every 4 weeks. Results After 12 months from the end of radiotherapy, the overall survival (OS) rate was 59% (20/38), distributed as follows: 60% (18/30) for recursive partitioning analysis (RPA) class 4 patients and 33% (1/3) for RPA class 6 patients; the only RPA class 1 patient was alive and disease free at the time of writing. Median OS was 13 months [95% confidence interval (CI) 11.02–14.98 months]. Hematological toxicity was seen in six patients (18%): grade 1 neutropenia in four, grade 2 thrombocytopenia in one, and grade 4 thrombocytopenia plus grade 1 neutropenia in one. There was one case of opportunistic infection ( Pneumocystis carinii pneumonitis). Conclusion The toxicity of the TMZ dose-dense regimen was very low. Results seem to be encouraging for RPA lower classes (patients with good prognostic factors).