Survival with dacarbazine and fotemustine in newly diagnosed glioblastoma multiforme

Fazeny-Dörner, Barbara; Veitl, Mario; Wenzel, Catharina; Rössler, Karl; Ungersböck, K.; Dieckmann, Karin; Piribauer, Maria; Hainfellner, Johannes A.; Marosi, Christine

doi:10.1038/sj.bjc.6600769

Cited by 15 publications

(8 citation statements)

References 38 publications

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“…In one patient relapse occurred in the contralateral hemisphere. The median number of delivered fotemustine courses was nine (range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; treatment with fotemustine started within 10 days after radiological diagnosis of recurrence.…”

Section: First Progressionmentioning

confidence: 99%

Second-line chemotherapy with fotemustine in temozolomide-pretreated patients with relapsing glioblastoma: a single institution experience

Scoccianti¹,

Detti²,

Sardaro

et al. 2008

Anti-Cancer Drugs

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To evaluate efficacy and safety of fotemustine chemotherapy in temozolomide (TMZ) pretreated adults with recurrent glioblastoma multiforme (GBM). Primary endpoint was progression-free survival at 6 months. Twenty-seven patients (median age: 56 years; median Karnofsky performance status at progression: 80) with relapsed glioblastoma multiforme underwent fotemustine as second-line chemotherapy after failure of homogeneous postoperative treatment consisting of conformal radiotherapy (60 Gy in 30 fractions) with concomitant TMZ (75 mg/m2 per day), followed by six courses of TMZ (150-200 mg/m2 for 5 days every 28 days). Patients were assigned to Radiation Therapy Oncology Group recursive partitioning analysis classes for gliomas. After MRI-proven tumor relapse or progression, all patients underwent chemotherapy with fotemustine, given intravenously 100 mg/m2 every week for 3 consecutive weeks (induction phase) and then every 3 weeks (maintenance phase). Adequate liver, renal, and bone marrow functions were required. Toxicity grading was based on the National Cancer Institute's Common Toxicity Criteria (version 2.0). Response to treatment was assessed on MacDonald criteria. According to an intention-to-treat-analysis, data on all enrolled patients were included in statistical analysis. Eight partial responses (29.6%) and five cases of stable disease (18.5%) were observed. Median time to progression was 5.7 months. Progression-free survival at 6 months was 48.15%. Median survival from the beginning of fotemustine chemotherapy was 9.1 months. Median survival from diagnosis of glioblastoma was 21.2 months. Toxicity was manageable and mainly hematological (grade 3 thrombocytopenia: three cases; grade 4 leukopenia: one case). Fotemustine has shown therapeutic efficacy as single-drug second-line chemotherapy in treatment of TMZ pretreated patients.

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Section: First Progressionmentioning

confidence: 99%

Second-line chemotherapy with fotemustine in temozolomide-pretreated patients with relapsing glioblastoma: a single institution experience

Scoccianti¹,

Detti²,

Sardaro

et al. 2008

Anti-Cancer Drugs

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“…Before temozolomide was available as first-line treatment, patients (n = 10; 24%) were treated with alkylating agents, e.g. dacarbazine and fotemustine [21]. Chemotherapy comprised only temozolomide in 16 patients (38%).…”

Section: Resultsmentioning

confidence: 99%

Gamma Knife Radiosurgery in Recurrent Glioblastoma

Frischer

Marosi

Wöehrer³

et al. 2016

Stereotact Funct Neurosurg

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Background: We evaluated Gamma Knife radiosurgery (GKRS) as a treatment option for patients with recurrent glioblastoma. Patients and Methods: 42 patients with histopathologically diagnosed recurrent grade IV tumor were treated with GKRS. All patients had undergone standard multimodal first-line treatment. The average time from diagnosis to GKRS was 17.0 months. The median target volume was 5.1 cm³. The median margin dose was 10 Gy and the median central dose 20 Gy. In a subset of patients, O⁶-methylguanine methyltransferase (MGMT) promoter methylation analysis by pyrosequencing was performed. Results: Most patients did not develop complications after GKRS. Time to radiological progression after initial GKRS was 4.4 months (95% CI: 3.1-5.7 months). Radiological progression mainly occurred beyond the GKRS-irradiated area. The median survival time after initial GKRS was 9.6 months (95% CI: 7.7-11.5 months). The median overall survival time from diagnosis was 25.6 months (95% CI: 21.8-29.3 months). Patients with MGMT promoter methylation survived significantly longer (33.4 months; 95% CI: 21.2-45.5 months) compared to patients without MGMT promoter methylation (16.0 months; 95% CI: 8.0-23.9 months). Conclusion: GKRS seems to be a relatively safe salvage treatment option for recurrent glioblastoma for highly selected patients but must be seen as part of a multimodal treatment algorithm.

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“…However, some patients opt for an alternative intravenous treatment with fotemustine/dacarbacine given every three weeks in an outpatient schedule and where outcome is quite similar to TMZ, without the risk of the pneumocystis carinii pneumonia and with slightly more haematological toxicity at the end of the treatment schedule [27]. This treatment is particularly suitable for patients with compliance problems.…”

Section: Are There Alternatives To Temozolomide?mentioning

confidence: 96%

Chemotherapy for malignant gliomas

Marosi

2006

Wien Med Wochenschr

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Concomitant and adjuvant treatment with Temozolomide, an oral alkylating agent, has significantly improved the survival of patients with newly diagnosed glioblastoma multiforme (study EORTC 26981/22981, NCIC CE3). When given with the appropriate cautiousness including weekly clinical and laboratory controls during the concomitant phase, this therapy is generally well tolerated. The observed toxicity is mainly haematological. Grade III and IV toxicities mainly thrombocytopenia or lymphocytopenia occur in around 5 % of patients. A prophylaxis against pneumocystis carinii pneumonia was mandatory in the EORTC study. Most importantly, the quality of life of the patients was maintained throughout the therapy. This success has boosted the whole field of neurooncology, after a dry spell of more than thirty years for glioblastoma multiforme. Whether this concept will be applicable to other brain tumours and which schedule modifications or combinations with biologicals will improve the effectivity of therapy in brain tumours should be explored in further studies.

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Survival with dacarbazine and fotemustine in newly diagnosed glioblastoma multiforme

Cited by 15 publications

References 38 publications

Second-line chemotherapy with fotemustine in temozolomide-pretreated patients with relapsing glioblastoma: a single institution experience

Second-line chemotherapy with fotemustine in temozolomide-pretreated patients with relapsing glioblastoma: a single institution experience

Gamma Knife Radiosurgery in Recurrent Glioblastoma

Chemotherapy for malignant gliomas

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