P17.69 * FOTEMUSTINE TRATMENT: WHAT ABOUT GLIOBLASTOMA PATIENTS' QUALITY OF LIFE?

Abstract

Glioblastoma Multiforme (GBM) is the most common and aggressive type of adult primary central nervous system tumor. The median survival in GBM patients is about 14 months. The prognosis of GBM is poor and in addition there is a very high probability of recurrence. For most patients with newly diagnosed GBM, the gold standard first-line treatment is represented by postoperative radiotherapy plus temozolomide (TMZ). There is not yet a standard of care for treatment of recurrent GBM. Recent phase II studies have demonstrated the efficacy of fotemustine (FTM) in the treatment of recurrent gliomas. To the best of our knowledge, however, no studies have investigated the quality of life in GBM patients treated with FTM as second-line treatment. We therefore sought to assess the quality of life of recurrent glioblastoma patients treated with FTM standard schedule as proposed by Addeo et al. (a dose of 80 mg/sqm every 2 weeks for five consecutive administrations as the induction phase and every 4 weeks at 80 mg/sqm as the maintenance phase). We approached 54 recurrent glioblastoma patients treated with FTM. Of these 54 eligible patients, we excluded 4 patients because they were not willing to participate in the research study and 10 because they did not meet one of the inclusion criteria, i.e. Mini Mental State Examination ≥ 25. We evaluated overall patients' quality of life through various tools: European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC brain cancer module (QLQ-BN20), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory form Y (STAI-Y), Hospital Anxiety and Depression Scale (HADS), Psychological Distress Inventory (PDI). Of the total of 40 patients, 18 patients completed the battery of tests both at the beginning of therapy and 2 months after the start of therapy. We found that patients reported higher levels of distress at two months after the start of therapy (mean value = 22.4) as compared to those experienced at the beginning of the therapy (mean value = 24.5), t (17) = -2.59, p < .05). Although patients' anxiety and depression levels and their quality of life were not compromised, it is interesting to note that distress levels are formerly high at the beginning of the therapy and increase after two months. This finding underlines the necessity to taking into account patients' emotional distress in the first phase of second-line treatment in order to promote a better adjustment to a new condition of life in which patients have mainly to deal with the fact that they cannot be cured of their disease.