Patil V M, Tonse R, Kothari R, Chandrasekaran A, Pande N, 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. 2017 Jan-Mar;54(1):368-371. doi: 10.4103/ijc.IJC_173_17.
Temozolomide (TMZ) is an integral part of upfront treatment of high-grade gliomas. It is administered postsurgery as concurrent therapy with radiation and subsequently as adjuvant chemotherapy for 6-12 cycles. It is unknown whether rechallenge of salvage TMZ in previously treated high-grade glioma has any efficacy.
Patients treated with salvage rechallenged TMZ between January 2015 and August 2016 were included for this retrospective analysis. SPSS version 20 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 was noted in accordance with CTCAE version 4.02.
A total of 23 patients were selected for analysis with the median age being 43 years (range: 26-69 years). The tumor histopathology at baseline was astrocytoma Grade 2 in 1 patient, oligodendroglioma Grade 2 in 3 patients, anaplastic astrocytoma in 7 patients, anaplastic oligodendroglioma in 2 patients, and glioblastoma in 10 patients. All of them had previously received TMZ. The median numbers of previous TMZ cycles received were 6 (4-18). The median time to failure postlast treatment was 24 months (5-72 months). The median number of cycles of rechallenged salvage TMZ administered was 6 cycles (range: 1-18). Grade 3-4 myelosuppression was seen in 3 patients (13.4%). The median PFS was 459 days (95% confidence interval: 212.1-705.9). The median OS was 25 months. Six-month OS and 1-year OS were 81.4% and 75.1%, respectively.
Rechallenge with TMZ in recurrent glioma that had previously responded to TMZ is associated with improvement in PFS and OS and has a sufficiently long disease-free interval.
替莫唑胺（TMZ）是高级别胶质瘤初始治疗的重要组成部分。术后它与放疗同时进行，随后作为辅助化疗进行6 - 12个周期。之前接受过治疗的高级别胶质瘤再次使用挽救性TMZ是否有效尚不清楚。
纳入2015年1月至2016年8月期间接受挽救性再次使用TMZ治疗的患者进行这项回顾性分析。使用SPSS 20版进行此分析。采用Kaplan-Meier方法进行事件发生时间分析。估计无进展生存期（PFS）和总生存期（OS）。根据CTCAE 4.02版记录最大毒性级别。
共选择23例患者进行分析，中位年龄为43岁（范围：26 - 69岁）。基线时肿瘤组织病理学为1例2级星形细胞瘤、3例2级少突胶质细胞瘤、7例间变性星形细胞瘤、2例间变性少突胶质细胞瘤和10例胶质母细胞瘤。他们均曾接受过TMZ治疗。之前接受TMZ治疗的中位周期数为6个（4 - 18个）。末次治疗后失败的中位时间为24个月（5 - 72个月）。再次使用挽救性TMZ治疗的中位周期数为6个周期（范围：1 - 18个）。3例患者（13.4%）出现3 - 4级骨髓抑制。中位PFS为459天（95%置信区间：212.1 - 705.9）。中位OS为25个月。6个月和1年的OS分别为81.4%和75.1%。
曾对TMZ有反应的复发性胶质瘤再次使用TMZ与PFS和OS的改善相关，且有足够长的无病间期。
