Patil V M, Abhinav R, Tonse R, Epari S, Gupta T, Jalali R
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Cancer. 2016 Oct-Dec;53(4):558-561. doi: 10.4103/0019-509X.204774.
In our center, we routinely use CCNU (Lomustine) as salvage treatment in high-grade glioma patients who cannot afford bevacizumab. This exploratory analysis was done to report the efficacy and toxicity associated with this regimen.
Patients who were treated with salvage CCNU (postexposure to temozolomide) between January 2015 and August 2016 were included for this retrospective analysis. SPSS version 16 was used for this analysis. Time-to-event analysis was performed using the Kaplan-Meier method. Progression-free survival (PFS) and overall survival (OS) were estimated. The maximum grade of toxicity during salvage CCNU was noted in accordance with CTCAE version 4.02.
In the stipulated period, 16 patients were selected for the analysis. The median age of patients was 43 years (range 15-63 years), and 12 (80.0%) patients were males. The Eastern Cooperative Oncology Group performance status was 0-1 in 11 patients (73.3%) and 2-4 in 4 patients (26.7%). The tumor histopathology at diagnosis was glioblastoma in ten patients (66.6%), anaplastic astrocytoma in four (26.7%) patients, and anaplastic oligodendroglioma in one patient (6.7%). Grade 3-4 myelosuppression was seen in five patients (33.3%). The median PFS and OS were 192 days (95% confidence interval [CI]: 156.0-227.5 days) and 282 days (95% CI: 190.9-373.1 days), respectively.
CCNU is associated with modest treatment outcomes in recurrent/relapsed high-grade gliomas. The high rate of myelosuppression is a concern. Urgent efforts are required to improve upon these results.
在我们中心，对于负担不起贝伐单抗的高级别胶质瘤患者，我们常规使用洛莫司汀（CCNU）作为挽救治疗。进行这项探索性分析以报告该治疗方案的疗效和毒性。
纳入2015年1月至2016年8月间接受挽救性CCNU治疗（替莫唑胺暴露后）的患者进行这项回顾性分析。使用SPSS 16版进行此分析。采用Kaplan-Meier方法进行生存时间分析。估计无进展生存期（PFS）和总生存期（OS）。根据CTCAE 4.02版记录挽救性CCNU治疗期间的最大毒性级别。
在规定期间，选择16例患者进行分析。患者的中位年龄为43岁（范围15 - 63岁），12例（80.0%）为男性。东部肿瘤协作组（ECOG）体能状态评分为0 - 1分的患者有11例（73.3%），2 - 4分的患者有4例（26.7%）。诊断时肿瘤组织病理学为胶质母细胞瘤的患者有10例（66.6%），间变性星形细胞瘤患者4例（26.7%），间变性少突胶质细胞瘤患者1例（6.7%）。5例患者（33.3%）出现3 - 4级骨髓抑制。中位PFS和OS分别为192天（95%置信区间[CI]：156.0 - 227.5天）和282天（95% CI：190.9 - 373.1天）。
CCNU在复发性/难治性高级别胶质瘤中具有一定的治疗效果。骨髓抑制发生率高是一个问题。需要迫切努力改善这些结果。
