Temozolomide three weeks on and one week off as first line therapy for patients with recurrent or progressive low grade gliomas

Abstract

Patients with recurrent or progressive low grade gliomas survive for a decade or more following diagnosis, and may be at a higher risk for treatment-related complications, such as cognitive impairment from radiotherapy. The aim of the present study was to determine in patients with progressive or recurrent low grade gliomas, the response rate and toxicity incurred by a continued schedule of temozolomide chemotherapy administered before radiation therapy, and to explore correlations between response and survival with 1p/19q deletions and MGMT promoter methylation status. Progressive radio and chemotherapy naïve low grade glioma patients with O(6)-methyl-guanine-DNA-methyl-tranferase (MGMT) promoter status evaluation were considered eligible. Chemotherapy cycles consisted of temozolomide 75 mg/m(2)/daily for 21 days every 28 days for 12 cycles. A total of 30 patients (median age 45 [range: 24.2-68.6] years) with a median KPS of 90 (range 60-90) were accrued. The overall response rate was 30% (9 partial responses); 17 patients (56.7%) had disease stabilization. The prolonged temozolomide schedule considered in the present study is followed by a high response rate; toxicity is acceptable. Further randomized trials should therefore be conducted to confirm the efficacy of this regimen as first-line therapy in patients with progressive low grade glioma.