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Multi‐institutional phase II study of temozolomide administered twice daily in the treatment of recurrent high‐grade gliomas
Author(s) -
Balmaceda Casilda,
Peereboom David,
Pannullo Susan,
Cheung Ying Kuen K.,
Fisher Paul G.,
Alavi Jane,
Sisti Michael,
Chen Johnson,
Fine Robert L.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23167
Subject(s) - medicine , temozolomide , neutropenia , anaplastic astrocytoma , toxicity , dosing , glioma , phases of clinical research , progression free survival , dacarbazine , lomustine , surgery , gastroenterology , chemotherapy , oncology , astrocytoma , vincristine , cyclophosphamide , cancer research
Abstract BACKGROUND. The prognosis for patients with recurrent high‐grade gliomas is poor and treatment options are limited. Current chemotherapeutic regimens can improve clinical outcomes, but extend survival by only a few months. Temozolomide is a methylating agent that is typically administered once daily. Because preclinical studies suggested that a twice‐daily dosing schedule might be more effective, the safety and efficacy of twice‐daily dosing of temozolomide were studied in patients with recurrent gliomas at their first, second, or third recurrence. METHODS. This multi‐institutional trial enrolled 120 patients with recurrent glioblastoma multiforme (GBM), anaplastic astrocytoma (AA), or anaplastic oligodendroglioma (AO). An initial oral dose of 200 mg/m 2 of temozolomide was followed by 9 consecutive doses of 90‐mg/m 2 every 12 hours. Treatment cycles were repeated every 28 days. Doses were escalated to 100 mg/m 2 twice daily in the absence of unacceptable toxicity or were reduced if unacceptable toxicity occurred. RESULTS. For GBM, AA, and AO patients, respectively, the median progression‐free survival (PFS) was 4.2 months, 5.8 months, and 7.7 months, whereas the median overall survival (OS) was 8.8 months, 14.6 months, and 18 months. The overall response rate (partial and complete) for the GBM, AA, and AO patients was 31%, 46%, and 46%, respectively. Grade 3/4 toxicities included neutropenia (1.1%), thrombocytopenia (3.6%), and anemia (0.3%) (graded according to the World Health Organization grading system). CONCLUSIONS. Twice‐daily dosing may enhance the efficacy of temozolomide in the treatment of recurrent gliomas without increasing toxicity. This regimen compares favorably with other dosing schedules of temozolomide reported in the literature. Cancer 2008. © 2008 American Cancer Society.