TITLE:
Extended Daily Schedule of Temozolomide in Recurrent Glioblastoma: Single-Institution Report on a Series of 43 Patients
AUTHORS:
Alessandro D’Elia, Vincenza Maiola, Mirena Manucci, Angelo Pichierri, Alessandro Frati, Felice Giangaspero, Maurizio Salvati
KEYWORDS:
Glioblastoma; Recurrence; Progression; Temozolomide; Metronomic Chemotherapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.2,
February
10,
2014
ABSTRACT: Background: Despite
advances in surgical and first-line adjuvant treatment, glioblastoma multiforme
(GBM) always recurs as disease natural history. Currently, there is no
consensus as to the optimal second-line treatment of recurrent GBM. Patients
and Methods: This is a retrospective
study of a series of adult patients consecutively treated at a single
institution for supratentorial cerebral GBM at first relapse. All patients had
previously received the standard concomitant radiochemotherapy protocol as
first-line therapy. At recurrence/progression, all patients were treated with a
metronomic temozolomide (TMZ) schedule at a daily dosage of 50 mg/m2 of body surface. Radiologic, clinical, and laboratory data were collected for
all patients, with a minimum follow-up of 18 months. Results: From January 2010 to June 2011, 43 patients were
treated at our facility. A mean of 10 metronomic TMZ cycles (range, 3 - 21)
was administered. Radiologically, we observed 2 complete responses (4.6%), 16 partial responses
(37.2%), 18 stable disease (41.9%) and 7 progressive disease (16.3%). Steroids
administration was safely tapered in 23 patients (53.5%). Karnofsky-Performance-Status
(KPS) results improved in 20 patients (46.5%), stabilized in 20 (46.5%), and
worsened in 3 patients (7.0%), with a mean KPS score increased from 65.1 at
baseline to 75.3 at follow-up. Six-month progression-free survival was 53.5.
One year after recurrence/progression diagnosis, 22 patients were still alive,
with a 1-year overall survival rate of 51.6%. Conclusions: The proposed TMZ schedule seems a safe and
effective option for patients with recurrent GBM, with high radiologic response
rates and good clinical impact. Strict clinical observation of patients may
enable obtaining better results than those already present in the literature
and further investigation appears auspicable.