Raizer J J, Giglio P, Hu J, Groves M, Merrell R, Conrad C, Phuphanich S, Puduvalli V K, Loghin M, Paleologos N, Yuan Y, Liu D, Rademaker A, Yung W K, Vaillant B, Rudnick J, Chamberlain M, Vick N, Grimm S, Tremont-Lukats I W, De Groot J, Aldape K, Gilbert M R
Department of Neurology, Northwestern University, 710 North Lake Shore Drive, Abbott Hall, Room 1123, Chicago, IL, 60611, USA.
James Cancer Hospital, Ohio State University, Columbus, OH, USA.
J Neurooncol. 2016 Jan;126(1):185-192. doi: 10.1007/s11060-015-1958-z.
Survival for glioblastoma (GBM) patients with an unmethyated MGMT promoter in their tumor is generally worse than methylated MGMT tumors, as temozolomide (TMZ) response is limited. How to better treat patients with unmethylated MGMT is unknown. We performed a trial combining erlotinib and bevacizumab in unmethylated GBM patients after completion of radiation (RT) and TMZ. GBM patients with an unmethylated MGMT promoter were trial eligible. Patient received standard RT (60 Gy) and TMZ (75 mg/m2 × 6 weeks) after surgical resection of their tumor. After completion of RT they started erlotinib 150 mg daily and bevacizumab 10 mg/kg every 2 weeks until progression. Imaging evaluations occurred every 8 weeks. The primary endpoint was overall survival. Of the 48 unmethylated patients enrolled, 46 were evaluable (29 men and 17 women); median age was 55.5 years (29-75) and median KPS was 90 (70-100). All patients completed RT with TMZ. The median number of cycles (1 cycle was 4 weeks) was 8 (2-47). Forty-one patients either progressed or died with a median progression free survival of 9.2 months. At a follow up of 33 months the median overall survival was 13.2 months. There were no unexpected toxicities and most observed toxicities were categorized as CTC grade 1 or 2. The combination of erlotinib and bevacizumab is tolerable but did not meet our primary endpoint of increasing survival. Importantly, more trials are needed to find better therapies for GBM patients with an unmethylated MGMT promoter.
肿瘤中MGMT启动子未甲基化的胶质母细胞瘤(GBM)患者的生存期通常比MGMT启动子甲基化的肿瘤患者更差,因为替莫唑胺(TMZ)的疗效有限。如何更好地治疗MGMT未甲基化的患者尚不清楚。我们进行了一项试验,在放疗(RT)和TMZ治疗结束后,将厄洛替尼和贝伐单抗联合用于MGMT未甲基化的GBM患者。MGMT启动子未甲基化的GBM患者符合试验条件。患者在肿瘤手术切除后接受标准RT(60 Gy)和TMZ(75 mg/m²×6周)治疗。RT结束后,他们开始每天服用150 mg厄洛替尼,每2周服用10 mg/kg贝伐单抗,直至病情进展。每8周进行一次影像学评估。主要终点是总生存期。在纳入的48例MGMT未甲基化患者中,46例可评估(29例男性和17例女性);中位年龄为55.5岁(29 - 75岁),中位KPS为90(70 - 100)。所有患者均完成了RT联合TMZ治疗。中位周期数(1个周期为4周)为8(2 - 47)。41例患者病情进展或死亡,中位无进展生存期为9.2个月。在33个月的随访中,中位总生存期为13.2个月。没有出现意外毒性,大多数观察到的毒性被归类为CTC 1级或2级。厄洛替尼和贝伐单抗联合用药耐受性良好,但未达到我们提高生存率的主要终点。重要的是,需要更多试验来为MGMT启动子未甲基化的GBM患者找到更好的治疗方法。