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Temozolomide low-dose chemotherapy in newly diagnosed low-grade gliomas: activity, safety, and long-term follow-up

Abstract

Purpose

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.

Tumori 2017; 103(3): 255 - 260

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000565

Authors

Veronica Villani, Roberta Merola, Antonello Vidiri, Alessandra Fabi, Mariantonia Carosi, Diana Giannarelli, Laura Marucci, Marta Maschio, Carmine M. Carapella, Andrea Pace

Article History

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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Authors

Affiliations

  •  Neuro-Oncology Unit, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Clinical Pathology Unit, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Service of Neuroradiology, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Division of Medical Oncology, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Neuropathology Unit, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Biostatistic Unit, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Division of Radiotherapy, “Regina Elena” National Cancer Institute, Rome - Italy
  •  Division of Neurosurgery, “Regina Elena” National Cancer Institute, Rome - Italy

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