Tabouret Emeline, Fabbro Michel, Autran Didier, Hoang-Xuan Khe, Taillandier Luc, Ducray François, Barrie Maryline, Sanson Marc, Kerr Christine, Cartalat-Carel Stephanie, Loundou Anderson, Guillevin Remy, Mokhtari Karima, Figarella-Branger Dominique, Delattre Jean-Yves, Chinot Olivier
APHM, CHU Timone, Service de Neurooncologie, Marseille, France.
Institut Régional du Cancer de Montpellier, Service de radiothérapie, Montpellier, France.
Oncologist. 2021 Aug;26(8):647-e1304. doi: 10.1002/onco.13765. Epub 2021 Apr 20.
Treatment with temozolomide and BCNU was associated with substantial response and survival rates for patients with unresectable anaplastic glioma, suggesting potential therapeutic alternative for these patients. The optimal treatment for unresectable large anaplastic gliomas remains debated.
The optimal treatment for unresectable large anaplastic gliomas remains debated.
Adult patients with histologically proven unresectable anaplastic oligodendroglioma or mixed gliomas (World Health Organization [WHO] 2007) were eligible. Treatment consisted of BCNU (150 mg/m ) and temozolomide (110 mg/m for 5 days) every 6 weeks for six cycles before radiotherapy.
Between December 2005 and December 2009, 55 patients (median age of 53.1 years; range, 20.5-70.2) were included. Forty percent of patients presented with wild-type IDH1 gliomas, and 30% presented with methylated MGMT promoter. Median progression-free survival (PFS), centralized PFS, and overall survival (OS) were 16.6 (95% confidence interval [CI], 12.8-20.3), 15.4 (95% CI, 10.0-20.8), and 25.4 (95% CI, 17.5-33.2) months, respectively. Complete and partial responses under chemotherapy were observed for 28.3% and 17% of patients, respectively. Radiotherapy completion was achieved for 75% of patients. Preservation of functional status and self-care capability (Karnofsky performance status [KPS] ≥70) were preserved until disease progression for 69% of patients. Grade ≥ 3 toxicities were reported for 52% of patients, and three deaths were related to treatment. By multivariate analyses including age and KPS, IDH mutation was associated with better prognostic for both PFS and OS, whereas MGMT promoter methylation was associated with better OS.
The association of BCNU and temozolomide upfront is active for patients with unresectable anaplastic gliomas, but toxicity limits its use.
替莫唑胺和卡氮芥治疗与不可切除的间变性胶质瘤患者的显著缓解率和生存率相关，提示这可能是这些患者的潜在治疗选择。对于不可切除的大型间变性胶质瘤的最佳治疗方法仍存在争议。
对于不可切除的大型间变性胶质瘤的最佳治疗方法仍存在争议。
组织学确诊为不可切除的间变性少突胶质细胞瘤或混合性胶质瘤（世界卫生组织[WHO]2007年）的成年患者符合条件。治疗方案为在放疗前每6周进行一次卡氮芥（150mg/m²）和替莫唑胺（110mg/m²，持续5天），共六个周期。
2005年12月至2009年12月期间，纳入55例患者（中位年龄53.1岁；范围20.5 - 70.2岁）。40%的患者为野生型异柠檬酸脱氢酶1（IDH1）胶质瘤，30%的患者为O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化。中位无进展生存期（PFS）、集中PFS和总生存期（OS）分别为16.6个月（95%置信区间[CI]，12.8 - 20.3）、15.4个月（95%CI，10.0 - 20.8）和25.4个月（95%CI，17.5 - 33.2）。化疗后分别有28.3%和17%的患者观察到完全缓解和部分缓解。75%的患者完成了放疗。69%的患者在疾病进展前保持功能状态和自我护理能力（卡诺夫斯基功能状态评分[KPS]≥70）。52%的患者报告有≥3级毒性反应，3例死亡与治疗相关。通过包括年龄和KPS的多因素分析，IDH突变与PFS和OS的预后较好相关，而MGMT启动子甲基化与较好的OS相关。
卡氮芥和替莫唑胺的联合一线治疗对不可切除的间变性胶质瘤患者有效，但毒性限制了其应用。
