8748 POSTER Medulloblastoma in Young Adults and Pancytopenia – Treatment Complication or Recurrence?

Abstract

Background: Malignant gliomas are aggressive primary brain tumours, which include anaplastic gliomas & glioblastoma (GBM). The majority of patients relapse following initial therapy & treatment options are limited. We reviewed patients with recurrent glioma treated with single agent bevacizumab at our centre from May 2009 to Dec 2010. Materials and Methods: Patients were identified from the pharmacy database & their records reviewed. Results: 15 patients were identified; data was available for 12. There were 9 men and 3 women with mean age at diagnosis of 47 (16– 62). Histology at original presentation was GBM in 7 patients, anaplastic astrocytoma in 4 and oligoastrocytoma in 1. All had at least subtotal debulking, with subsequent radiation. In 9 (75%), radiation was concurrent with temozolomide − 8 proceeded to temozolomide alone, 1 patient had progressive disease. 2 (17%) patients had radiation followed by procarbazine, lomustine, vincristine (P.C.V.) − chemotherapy was stopped early in both, due to toxicity in one and progressive disease in the other, this patient then received temozolomide. The 1 patient who originally had an oligoastrocytoma subsequently transformed to GBM, he had radiation followed by temozolomide at that point. Upon progression of disease, 5 patients had further debulking, with insertion of carmustine wafers in 2. Patients started on bevacizumab a median of 16 months from initial diagnosis (5−92), 9 had 10mg/kg 2 weekly, 3 received 7.5mg/kg secondary to performance status concerns. There was a median of 11 cycles administered (1−22). 4 patients are alive, 1 continues on bevacizumab at 4 months, 3 are off treatment due to decreased performance status, at a median 6 months (6−10) from commencing therapy. The other 8 patients died a median of 6 months from starting bevacizumab (1−12). 1 bled into their tumour, 1 had a saddle pulmonary embolism, the remainder died of progressive disease. All patients were on steroid therapy, 7 (58%) had a reduction in steroid dose on bevacizumab. 3 (25%) patients had an improved scan on treatment. The median overall survival was 6 months from commencement of bevacizumab. Conclusion: The management of patients with recurrent malignant glioma is challenging. Despite a median overall survival of 6 months in an unselected cohort, in addition to the ability to reduce steroid dose − which compares reasonably to historical controls -outcome for this group is still disappointing overall. We continue to seek novel therapeutic options for this aggressive disease.