Soffietti Riccardo, Nobile Mauro, Rudà Roberta, Borgognone Marzia, Costanza Alessandra, Laguzzi Elena, Mutani Roberto
Neuro-Oncology Service, Department of Neuroscience, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Cancer. 2004 Feb 15;100(4):807-13. doi: 10.1002/cncr.20042.
The efficacy of second-line chemotherapy for patients with recurrent or progressive oligodendroglial tumors is limited. In the current study, the authors investigated the use of carboplatin as a second-line chemotherapeutic agent against these types of tumors.
Twenty-three patients with recurrent or progressive oligodendrogliomas or oligoastrocytomas after first-line PCV (procarbazine, lomustine, and vincristine) chemotherapy were enrolled in a single-institution Phase II study of second-line carboplatin chemotherapy. All patients had undergone surgery, and most also had undergone conventional radiotherapy. Carboplatin was administered at a dose of 560 mg/m2 intravenously every 4 weeks. Responses were evaluated according to conventional criteria, based on magnetic resonance imaging (MRI) findings.
Three of 23 patients (13%) had partial responses, with neurologic improvement. Twelve patients (52%) had stable disease; in 2 of these 12 patients, a minor response was seen on MRI. Eight patients (35%) had progressive disease. The median time to tumor progression was 3 months for all patients and 9 months for patients who experienced responses to treatment. Progression-free survival rates at 6 and 12 months were 34.8% and 8.7%, respectively. Among the salvage treatment plans followed after carboplatin chemotherapy were supportive care alone, radiotherapy, third-line chemotherapy, and reoperation. The median survival duration from the start of carboplatin administration was 16 months. Myelotoxicity was severe, with Grade 3 or 4 thrombocytopenia in 60% of patients and Grade 3 or 4 neutropenia in 48% of patients.
When administered according to a monthly schedule, carboplatin exhibited modest activity in adult patients with recurrent or progressive oligodendroglioma or oligoastrocytoma who experienced treatment failure after PCV chemotherapy; the current treatment regimen also was associated with severe toxicity. Further improvement of second-line chemotherapy for the patient group examined in the current study is necessary.
复发性或进展性少突胶质细胞瘤患者的二线化疗疗效有限。在本研究中，作者调查了卡铂作为针对这类肿瘤的二线化疗药物的应用情况。
23例一线接受PCV（丙卡巴肼、洛莫司汀和长春新碱）化疗后出现复发或进展的少突胶质细胞瘤或少突星形细胞瘤患者参加了一项单机构二线卡铂化疗的II期研究。所有患者均接受了手术治疗，大多数还接受了常规放疗。卡铂以560mg/m²的剂量每4周静脉给药一次。根据基于磁共振成像（MRI）结果的常规标准评估反应情况。
23例患者中有3例（13%）出现部分缓解，神经功能得到改善。12例患者（52%）病情稳定；在这12例患者中的2例，MRI显示有轻微反应。8例患者（35%）病情进展。所有患者的肿瘤进展中位时间为3个月，对治疗有反应的患者为9个月。6个月和12个月时的无进展生存率分别为34.8%和8.7%。卡铂化疗后的挽救治疗方案包括单纯支持治疗、放疗、三线化疗和再次手术。从开始给予卡铂起的中位生存时间为16个月。骨髓毒性严重，60%的患者出现3级或4级血小板减少，48%的患者出现3级或4级中性粒细胞减少。
按照每月一次的给药方案，卡铂在PCV化疗后治疗失败的复发性或进展性少突胶质细胞瘤或少突星形细胞瘤成年患者中表现出适度活性；当前治疗方案也伴有严重毒性。对本研究中所研究的患者群体进一步改进二线化疗是必要的。
