Gruber Michael L, Buster Ward P
Department of Neurology, The Brain Tumor Center of New Jersey, Summit, New Jersey, USA.
Am J Clin Oncol. 2004 Feb;27(1):33-8. doi: 10.1097/01.coc.0000045852.88461.80.
The prognosis for patients with recurrent malignant glioma is poor. Both temozolomide and irinotecan have been shown to be active in this disease. A study was performed combining temozolomide 200 mg/m2 daily for 5 days and irinotecan 125 mg/m2 on days 6, 13, and 20 initially (Schedule A) and then changed to (Schedule B) temozolomide 200 mg/m2 daily for 5 days and irinotecan 350 mg/m2 on day 6. Each cycle was 28 days. All patients with recurrent tumor had to complete two cycles of therapy to be evaluable. Six cycles of treatment were provided for all responders. Thirty-two patients were treated, 6 with schedule A, 24 with schedule B, and 2 initially schedule A and then switched to schedule B. Eighteen patients (56%) had glioblastoma and 14 patients and anaplastic glioma (AOA 8, anaplastic astrocytoma 4, AO 2). Eighty-three percent (15/18) of patients with glioblastoma responded (complete response [CR] 2, partial response [PR] 3, stable disease [SD] 10). Median duration of response was 24 weeks, and 6-month progression-free survival (PFS) was 39% (7/18). Fourteen patients with anaplastic glioma were treated and all responded (CR 3, PR 2, SD 9). Median duration of response was 29 weeks and 6-month PFS was 71% (10/14). Grade IV leukopenia occurred in one patient and grade IV thrombocytopenia in two patients. Two patients were admitted to the hospital for neutropenic fever. Nonhematologic toxicity was mild and mostly gastrointestinal. These results demonstrate a favorable response and low toxicity with combined irinotecan and temozolomide therapy and warrant further clinical evaluation.
复发性恶性胶质瘤患者的预后较差。替莫唑胺和伊立替康已被证明对这种疾病有效。开展了一项研究，最初将替莫唑胺200mg/m²每日给药5天，并于第6、13和20天给予伊立替康125mg/m²（方案A），然后改为（方案B）替莫唑胺200mg/m²每日给药5天，并于第6天给予伊立替康350mg/m²。每个周期为28天。所有复发性肿瘤患者必须完成两个周期的治疗才能进行评估。所有有反应的患者接受六个周期的治疗。32例患者接受了治疗，6例采用方案A，24例采用方案B，2例最初采用方案A，随后改为方案B。18例患者（56%）患有胶质母细胞瘤，14例患者患有间变性胶质瘤（间变性少突胶质细胞瘤8例，间变性星形细胞瘤4例，间变性少突星形细胞瘤2例）。83%（15/18）的胶质母细胞瘤患者有反应（完全缓解[CR]2例，部分缓解[PR]3例，疾病稳定[SD]10例）。中位反应持续时间为24周，6个月无进展生存期（PFS）为39%（7/18）。14例间变性胶质瘤患者接受了治疗，所有患者均有反应（CR 3例，PR 2例，SD 9例）。中位反应持续时间为29周，6个月PFS为71%（10/14）。1例患者发生IV级白细胞减少，2例患者发生IV级血小板减少。2例患者因中性粒细胞减少性发热入院。非血液学毒性较轻，主要为胃肠道毒性。这些结果表明，伊立替康和替莫唑胺联合治疗反应良好且毒性较低，值得进一步临床评估。
