Chemotherapy in the treatment of recurrent glioblastoma multiforme: ifosfamide versus temozolomide |
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Authors: | Frank Paulsen Wolfgang Hoffmann Gerd Becker Claus Belka Martin Weinmann Johannes Classen Rolf-Dieter Kortmann Michael Bamberg |
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Institution: | (1) Department of Radiotherapy, University of Tübingen, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany Tel.: 49 7071 2986142, Fax: 49 7071 295984, e-mail: frank.paulsen@uni-tuebingen.de, DE |
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Abstract: | Purpose: Despite the progress made in neurosurgery and radiotherapy, the prognosis of glioblastoma multiforme (GB) is poor, due to
the lack of an effective salvage therapy. In vitro analysis revealed activity for ifosfamide and temozolomide. The usefulness
of these agents in recurrent disease was investigated. Methods: Six adult patients with recurrent GB received one to four courses of 1,500 mg/m2 ifosfamide given over 5 days intravenously. Furthermore, temozolomide (100–200 mg/m2) was given orally over 5 days to 14 patients. Results: After ifosfamide treatment, one partial response and two cases of stable disease were observed. The median survival time
was 24 weeks (range of 9–52 weeks). Toxicity analysis revealed one paranoid reaction, three grade III leukocytopenia, and
one grade I–II nausea, anemia, and hematuria. Temozolomide therapy resulted in three partial responses and four cases of stable
disease. The median survival time (Kaplan-Meier) was 21 weeks (range 4–64 weeks). The major toxicities were grade I–II nausea
and hematological side effects (one case of grade IV leuko- and thrombocytopenia). Conclusions: Ifosfamide treatment might be a feasible approach, but it necessitates hospitalization. Temozolomide showed promising results.
Due to its oral application, the patient's quality of life (time out of hospital) is favorable. Subgroups with improved survival
were observed.
Received: 7 December 1998 / Accepted: 21 January 1999 |
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Keywords: | Malignant glioma Relapse Ifosfamide Temozolomide |
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