Overall survival of newly diagnosed glioblastoma patients receiving carmustine wafers followed by radiation and concurrent temozolomide plus rotational multiagent chemotherapy

BACKGROUND:

Glioblastoma multiforme (GBM), the most lethal type of brain tumor, has a 1‐year median survival. The effect of carmustine wafers on the survival of newly diagnosed GBM patients treated with radiotherapy (RT) and concurrent temozolomide (TMZ) plus RT plus rotational chemotherapy was investigated.

METHODS:

An institutional review board‐approved retrospective study was conducted in 85 newly diagnosed GBM patients who received surgical resection with and without carmustine wafers followed by RT and concurrent TMZ plus rotational chemotherapy. Treatment group comparisons were conducted using the log‐rank test. Survival experience of the Duke cohort was examined within specific patient subgroups defined by the original Radiation Therapy Oncology Group (RTOG) recursive partition analysis (RPA) class and compared with the European Organization for Research and Treatment of Cancer (Stupp) and RTOG trial.

RESULTS:

Overall 1‐ and 2‐year survival for the noncarmustine wafer cohort were 69% and 29%, respectively, with a median survival of 72.7 weeks. One‐ and 2‐year survival for the carmustine wafer cohort were 81% and 47%, with median survival of 89.5 weeks. Carmustine wafer was not an independent predictor (P = .110) of survival after adjustment for RPA class. The proportion of patients in the carmustine wafer cohort who lived longer than predicted based upon Stupp regimen results was significantly greater than 0.5 (P<.006); similar results based upon the RTOG trial data were observed (P < .001).

CONCLUSIONS:

Carmustine wafer with concurrent TMZ and radiation followed by rotational chemotherapy is a well tolerated, effective therapy, and has a survival benefit compared with radiation alone. Prospective randomized trials are needed to rigorously compare the carmustine wafer regimen to the Stupp and postradiation multimodality regimens. Cancer 2009. © 2009 American Cancer Society.     

Temozolomide for recurrent intracranial supratentorial platinum‐refractory ependymoma

BACKGROUND:

To the authors' knowledge, there currently is no standard therapy for platinum‐resistant ependymoma; hence, a need exists for new therapies. In the current study, a retrospective evaluation of temozolomide (TMZ) in adults with recurrent, supratentorial, platinum‐refractory, World Health Organization grade 2 ependymoma was performed, with an objective of determining 6‐month progression‐free survival (PFS).

METHODS:

A total of 25 patients, ages 28 to 63 years, with recurrent ependymoma were treated. All patients had previously been treated with surgery, radiotherapy, and platinum‐based chemotherapy (cisplatin in 15 patients and carboplatin in 10 patients). Nine patients underwent repeat surgery. Patients were treated at the time of second recurrence with TMZ (5 consecutive days), once every 4 weeks, which was defined as a single cycle. Neurologic evaluation was performed every 4 weeks and neuroradiographic assessment every 8 weeks.

RESULTS:

A total of 68 cycles of TMZ (median, 2 cycles; range, 1‐6 cycles) was administered. TMZ‐related toxicity included leukopenia (7 patients; 1 with grade 3 [grade was determine according to National Cancer Institute Common Toxicity Criteria [version 3.0]), constipation (6 patients; none with grade 3), fatigue (5 patients; none with grade 3), anemia (2; none with grade 3), thrombocytopenia (2; none with grade 3), and deep vein thrombosis (2; none with grade 3). One patient (4%) demonstrated a partial radiographic response, 9 (36%) had stable disease, and 15 (60%) developed progressive disease after 2 cycles of TMZ. Time to tumor progression ranged from 1 to 7 months (median, 2 months). Survival ranged from 2 to 8 months (median, 3 months). The 6‐month and 12‐month PFS were 2% and 0%, respectively.

CONCLUSIONS:

TMZ in this dose schedule demonstrated little efficacy in a cohort of adults with recurrent, intracranial, platinum‐refractory ependymoma. Cancer 2009. © 2009 American Cancer Society.     

鸦胆子油乳联合阿帕替尼及替莫唑胺治疗复发性恶性脑胶质瘤

目的探讨鸦胆子油乳联合阿帕替尼及替莫唑胺治疗复发性恶性脑胶质瘤患者的临床疗效、免疫功能影响及不良反应。方法选取2016年6月至2018年12月期间郑州大学第一附属医院复发性恶性脑胶质瘤患者52例,随机分为2组,A组26例应用阿帕替尼及替莫唑胺治疗,B组26例应用鸦胆子油乳联合阿帕替尼及替莫唑胺治疗,比较2组临床疗效、免疫功能及不良反应。结果治疗后,B组客观缓解率为69.23%,高于A组的38.46%(P<0.05)。治疗后,A组CD3+T细胞、CD4+辅助性T细胞、CD4+/CD8+较治疗前显著降低(P均<0.05),而B组上述指标较治疗前显著升高(P均<0.05),且均显著高于A组(P<0.05)。治疗后,B组KPS评分高于治疗前,且高于A组(P均<0.05)。B组不良反应发生率低于A组,但差异无统计学意义(P>0.05),且不良反应轻微可耐受,对症处理后消失。B组6个月疾病无进展生存率65.4%、中位疾病无进展生存期7.56个月(95%CI:5.72~9.40个月)、中位总生存期10.14个月(95%CI:8.59~11.70个月),均明显高于A组的46.2%、5.78个月(95%CI:4.64~6.92个月)、8.73个月(95%CI:8.22~9.25个月)(P均<0.05)。结论鸦胆子油乳联合阿帕替尼及替莫唑胺治疗复发性恶性脑胶质瘤可提高近期临床治疗效果,调节患者免疫功能,改善其生活质量和生存,且安全性良好,值得临床应用推广。     

影响术后接受替莫唑胺联合放疗治疗的脑胶质瘤患者的预后风险因素分析

目的替莫唑胺同步放疗可以显著提高术后脑胶质瘤患者的生存期,改善患者生存质量。本研究旨在探索影响术后接受替莫唑胺联合放疗治疗的脑胶质瘤患者的预后风险因素。方法本研究从2010年1月至2018年6月回顾性收集175例手术切除后接受替莫唑胺联合放疗辅助治疗的脑胶质瘤患者。收集患者资料及治疗情况病例记录,后期随访患者的预后生存情况。分析入组患者的无进展生存期(PFS)和总生存期(OS)数据。构建Cox多变量模型分析影响患者OS的风险因素。结果纳入研究的175例患者均可评估预后,175例患者的中位PFS为6.4个月(95%CI:5.62~7.18),中位OS为13.6个月(95%CI:11.08~16.12)。Cox模型当中对OS具有独立影响意义的变量为年龄(OR=1.45,P=0.025),ECOG评分(OR=1.77,P=0.011),WHO分级(OR=2.11,P=0.003)和手术范围(OR=1.85,P=0.009)。不良反应均为1~2级,未发现3级以上不良反应。结论替莫唑胺联合放疗的方案在术后脑胶质瘤患者中具有相应的疗效及安全性。患者的年龄、ECOG评分、WHO分级和手术切除程度是影响患者预后的风险因素。     

肿瘤治疗电场联合替莫唑胺化疗与单独使用替莫唑胺化疗对胶质母细胞瘤临床疗效比较的Meta分析

目的 探讨单独使用替莫唑胺（TMZ）与替莫唑胺联合肿瘤治疗电场（TTF）治疗胶质母细胞瘤安全性和疗效的比较。方法 检索Pubmed、Cochrance、Embase、Ovid、Scopus、Web of Science、中国知网、万方数据知识服务平台、维普中文期刊数据库、中国生物医学文献服务系统数据库、谷歌学术自建库至2020年4月5日的文献，筛选TMZ和TTF+TMZ进行疗效比较的随机对照研究，按照纳入和排除标准，把总体生存率（OS）和无进展生存期（PFS）作为结局指标，最后使用Review Manager进行统计分析。结果 最终纳入4篇研究，共1091例患者，其中单纯TMZ组381例，TTF+TMZ组710例。TTF+TMZ组的平均OS （26.9个月）和平均PFS （14.7个月），优于单纯TMZ组的平均OS （12.63个月）和平均PFS （5个月）（P<0.01）。结论 TTF+TMZ治疗GBM的有效性优于单纯使用TMZ的患者。     

Complete response of radioresistant brain metastases from non-small cell lung cancer with temozolomide: A case report and literature review

Rationale:Non-small cell lung cancer (NSCLC) patients with brain metastases (BMs) have been found as subjects of poor prognosis. Whole-brain radiotherapy (WBRT), surgery, and stereotactic radiosurgery, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), or some combinations are the most commonly employed strategies for the treatment of treatments BMs. However, some patients are resistant to all these treatments.Patient Concerns:We present an NSCLC patient with progression of BMs after treatment with WBRT and EGFR-TKIs. The patient was diagnosed with multiple metastases on July 9, 2014, and treated with docetaxel plus cisplatin chemotherapy followed with gefitinib as the maintenance therapy. The patient showed recurrence of BMs after 8-months of chemotherapy. WBRT with 30 Gy was administrated in 10 fractions. Tumor progression of the brain was diagnosed with an magnetic resonance imaging scan after 2-months of WBRT.Diagnoses:The patient was diagnosed as pulmonary adenocarcinoma with diffuse metastases in both lungs and multiple metastases in bone and brain. Progression of BMs was confirmed through magnetic resonance imaging.Interventions:This patient was administered temozolomide (150 mg/m²/d for 5 days every 28-day cycle). As a whole, 6 cycles were performed after the progression of BMs from August 2015.Outcomes:The patient got complete brain remission and lived without discomfort. The intracranial lesion did not progress until the progression of the lung lesion and led to death on February 20, 2019. The intracranial progression-free survival was 42 months, whereas the overall survival was 55 months.Lessons:For patients with NSCLC and BMs, temozolomide can be used as a treatment option, especially in patients with EGFR-TKIs resistance or without driver mutations.     

贝伐珠单抗联合替莫唑胺剂量密度方案治疗复发胶质瘤的疗效分析

目的:评价贝伐珠单抗联合替莫唑胺剂量密度方案治疗复发胶质瘤的疗效及不良事件。方法:回顾性分析20例接受过贝伐珠单抗联合替莫唑胺剂量密度方案治疗的复发胶质瘤患者的临床资料并进行生存随访。依据RANO标准评价客观疗效，应用Kaplan-Meier 法进行生存分析，不良事件评价依据CTCAE 4.0版标准。结果:20例复发胶质瘤患者的临床获益率和客观反映率可达到85%和60%，中位PFS和中位OS分别为3个月（1.5~11个月）和6.5个月（3~15个月）。主要不良事件为高血压。结论:贝伐珠单抗联合替莫唑胺剂量密度方案治疗复发胶质瘤安全有效，且耐受性良好。