Hydroxyurea for Treatment of Unresectable and Recurrent Meningiomas. II. Decrease in the Size of Meningiomas in Patients Treated with Hydroxyurea

Schrell, U.; Rittig, Michael; Anders, Marc; Koch, U; Marschalek, Rolf; Kiesewetter, F.; Fahlbusch, Rudolf

doi:10.1097/00041327-199712000-00050

Cited by 41 publications

(59 citation statements)

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“…A challenge in considering systemic therapy for recurrent surgery and radiation refractory high-grade meningioma is the paucity of clinical trials from which to base treatment [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. There is a small study of high-grade meningiomas treated following initial surgery with a sarcoma adjuvant # number, M male, F female, R right, L left, GTR gross total resection, STR subtotal resection, RT external beam radiotherapy, Gy gray, SRS stereotactic radiosurgery, HU hydroxyurea, PFS progression free survival chemotherapy regimen (cyclophosphamide, adriamycin and vincristine: CAV), but without a radiotherapy only control arm it is unclear what the contribution of CAV was to upfront radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…As outlined in a prior report, hydroxyurea (HU; Hydrea; Bristol-Myers-Squibb, NY) was administered orally for 28-consecutive days (1,000 mg/m 2 /single daily dose) every 4-weeks (operationally defined as a cycle of therapy) [9][10][11][12][13][14][15][16]26]. HU was obtained commercially and billed to third party payers.…”

Section: Drug Schedulementioning

confidence: 99%

“…The Central Nervous System (CNS) National Comprehensive Cancer Network (NCCN) guidelines, based on consensus expert opinion, suggests as treatment options hydroxyurea, a-interferon or Sandostatin LAR, a somatostatin inhibitor [8]. These recommendations however are based upon a comparatively small literature treating patients with surgery and radiation refractory meningiomas [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Similar to a prior report in concept and design, this retrospective case series determined progression free survival in 35 adult patients with recurrent high-grade meningiomas treated with the orally administered chemotherapy, hydroxyurea (HU), following progression after prior surgery and radiotherapy [26].…”

Section: Introductionmentioning

confidence: 99%

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Hydroxyurea for recurrent surgery and radiation refractory high-grade meningioma

Chamberlain

2011

J Neurooncol

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Hydroxyurea (HU), an orally administered chemotherapy, has become the de facto standard chemotherapeutic agent in patients with surgically and radiation refractory meningiomas based on a limited literature. A retrospective case series of 35 patients with recurrent WHO Grade 2 (n = 22) or 3 (n = 13) meningioma treated with HU following progression after surgery and radiotherapy was collated with primary study objectives of overall response rate, median and progression free survival (PFS) at 6-months. Thirty-five patients (25 women; 10 men: median age 63 years, range 34-86) with recurrent high-grade meningioma were treated with HU (1,000 mg/m(2) orally divided twice per day; one cycle operationally defined as 4 weeks of daily HU). Patients had progressed radiographically after prior therapy with surgery (35/35) and radiotherapy (35/35: external beam radiotherapy 35/35; stereotactic radiotherapy 35/35). No patient received prior chemotherapy or targeted therapy before instituting HU. Patients received 0.5-7 cycles (median 2.0) of HU with modest toxicity (28.5% all grades and 8.5% grade 3+ anemia or fatigue). There were no radiographic responses, 43% of patients had stable disease and 57% manifested progressive disease at first evaluation. The overall PFS was 3.0% at 6 months (median PFS 2.0 months; 95% CI 1.6-2.4). The majority of patients (80%) following progression on HU were subsequently treated on an investigational trial. In this retrospective series, HU though well tolerated and convenient appeared to have very limited activity, raise questions of what constitutes effective salvage therapy and indicates an unmet need for alternative treatments for recurrent high-grade meningiomas.

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Section: Discussionmentioning

confidence: 99%

Section: Drug Schedulementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hydroxyurea for recurrent surgery and radiation refractory high-grade meningioma

Chamberlain

2011

J Neurooncol

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“…Total extirpation is the treatment of choice for meningiomas, although there have been attempts at medical [14,15] or radiosurgical [16,17] treatment in selected cases. In the latter cases it is especially important to confirm the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing dural metastases: the value of 1 H magnetic resonance spectroscopy

et al. 2001

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The purpose of this study was to assess the value of MRI, MR spectroscopy (MRS) and intra-arterial angiography in the preoperative diagnosis of extra-axial dural-based masses. We prospectively studied 54 patients who underwent preoperative MRI, MRS and angiography. Histologically there were 50 meningiomas and four dural metastases. MRI and angiography did not allow reliable differentiation between meningiomas and metastases. MRS showed elevated choline/creatine ratios in both meningiomas and metastases, but there were prominent lipid signals in all metastases and a lactate peak in two. This spectroscopic pattern was not found in meningiomas. However, following embolisation, they showed similar spectra, due to ischaemia and necrosis. We therefore believe MRS to be valuable in differential diagnosis of dural metastases and meningiomas prior to embolisation.

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“…Not infrequently and as illustrated in the present retrospective series, sequential radiotherapy is employed for multiply recurrent meningioma. Less clear from the literature is how best to manage patients with surgery and radiotherapy refractory recurrent meningioma [11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The 2010 Central Nervous System National Comprehensive Cancer Network (CNS NCCN) guidelines suggest three possible treatments (hydroxyurea, alpha-interferon or somatostatin analogues such as Sandostatin LAR) recognizing that there is very meager literature (medical level evidence category 3) regarding the medical oncology management of recurrent meningioma [12-19, 21, 22].…”

Section: Introductionmentioning

confidence: 99%

Hydroxyurea for recurrent surgery and radiation refractory meningioma: a retrospective case series

Chamberlain

Johnston

2011

J Neurooncol

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Hydroxyurea (HU), an orally administered chemotherapy, has become the de facto standard therapeutic agent in patients with surgically and radiation refractory meningiomas based on a limited literature. A retrospective case series of 60 patients with recurrent WHO grade 1 meningioma treated with HU following progression after surgery and radiotherapy was conducted with primary study objective progression free survival (PFS) at 6- and 12-months. Sixty patients (45 women; 15 men: median age 61.5 years, range 26-88) with recurrent meningioma were treated with HU (1000 mg/m(2)/day orally divided twice per day; one cycle operationally defined as 4-weeks of daily HU). All patients had progressed radiographically after prior therapy with surgery (60/60) and radiotherapy (external beam radiotherapy 60/60; stereotactic radiotherapy 53/60). No patient received prior chemotherapy or targeted therapy before instituting HU. Patients received 1-12 cycles (median 2.0) of HU with modest toxicity (10% grade 3 + anemia or fatigue). There were no radiographic responses, 35% of patients had stable disease and 65% manifested progressive disease. Duration of stable disease ranged from 3 to 12 months (median 4.0 months). The overall PFS was 10% (median PFS 2.0 months). The majority of patients (80%) following progression on HU were subsequently treated on an investigational trial. In this retrospective case series, HU though generally well tolerated and convenient, appeared to have very limited activity which raises questions of what constitutes effective salvage therapy and indicates an unmet need for alternative treatments for recurrent meningiomas.

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Hydroxyurea for Treatment of Unresectable and Recurrent Meningiomas. II. Decrease in the Size of Meningiomas in Patients Treated with Hydroxyurea

Cited by 41 publications

References 0 publications

Hydroxyurea for recurrent surgery and radiation refractory high-grade meningioma

Hydroxyurea for recurrent surgery and radiation refractory high-grade meningioma

Diagnosing dural metastases: the value of 1 H magnetic resonance spectroscopy

Hydroxyurea for recurrent surgery and radiation refractory meningioma: a retrospective case series

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