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.
Highlights
Glioblastoma multiforme (GBM, grade IV according to the World Health Organization classification system) [1] is the most common and most malignant primitive cerebral tumor in the adult
Many alternative drugs are used in clinical practice—as in the experimental setting—such as lomustine and procarbazine, fotemustine, irinotecan and bevacizumab, tamoxifen, celecoxib, erlotinib, cediranib, and cilengitide, alone or in combination; even TMZ is considered as second-line chemotherapy with different schedules [3,4]
We present here our experience with a metronomic schedule of daily administration of TMZ, employed at a dosage of 50 mg/m2 of body surface, in patients with recurrent supratentorial adults glioblastoma multiforme (GBM) who were previously treated with standard adjuvant TMZ until disease progression
Summary
Glioblastoma multiforme (GBM, grade IV according to the World Health Organization classification system) [1] is the most common and most malignant primitive cerebral tumor in the adult. The recurrence process of a GBM develops quite invariably within 2 years from the diagnosis, and it accounts for patient clinical deterioration and death, which often occur in a few weeks or months Recently, it achieved a general consensus with regard to adjuvant treatment following surgical intervention (firstline therapy). Many alternative drugs are used in clinical practice—as in the experimental setting—such as lomustine and procarbazine, fotemustine, irinotecan and bevacizumab, tamoxifen, celecoxib, erlotinib, cediranib, and cilengitide, alone or in combination; even TMZ is considered as second-line chemotherapy with different schedules [3,4] These therapies show a limited response rate, and, even when effective, the duration of response is short and does not always result in improved overall survival (OS) or quality of life. Strict clinical observation of patients may enable obtaining better results than those already present in the literature and further investigation appears auspicable
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