Kyritsis A P, Yung W K, Jaeckle K A, Bruner J, Gleason M J, Ictech S E, Flowers A, Levin V A
Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Neurosurgery. 1996 Nov;39(5):921-6. doi: 10.1097/00006123-199611000-00006.
To determine the efficacy of the combination of 6-thioguanine, procarbazine, lomustine, and hydroxyurea for patients with recurrent malignant gliomas after failure of either previous radiotherapy alone or previous radiotherapy plus nitrosourea-based chemotherapy.
Seventy-seven patients with recurrent malignant gliomas were studied. 6-Thioguanine was administered for 4 days before lomustine, and procarbazine was administered for 1 day before and 2 days after lomustine to potentiate lomustine's antitumor effect. Hydroxyurea was initiated 1 day before lomustine and continued for a total of 3 days.
Thirty patients with glioblastomas and 47 patients with anaplastic gliomas were eligible for evaluation. In the glioblastoma group, 2 of 30 patients had a partial response and 8 of 30 patients had stable disease. This group of patients who responded and had stable disease included 6 of 10 patients who had not undergone previous chemotherapy but only 4 of 20 who had undergone previous chemotherapy. The overall median time to disease progression for the glioblastoma group was 9 weeks. In the anaplastic glioma group, 11 of 47 patients had a partial response and 25 of 47 had stable disease, including 23 of 30 without previous chemotherapy and 13 of 17 who had undergone previous chemotherapy. The median time to disease progression for the whole anaplastic glioma group was 24 weeks; however, the time to disease progression was 50 weeks for responding patients who had not undergone previous chemotherapy and 25 weeks for those who had undergone previous chemotherapy.
Our results indicate that chemotherapy with a combination of 6-thioguanine, procarbazine, lomustine, and hydroxyurea is active for patients with recurrent anaplastic gliomas and glioblastomas not previously treated with nitrosourea-based chemotherapy but is inactive for patients with glioblastomas previously treated with chemotherapy.
确定6-硫鸟嘌呤、丙卡巴肼、洛莫司汀和羟基脲联合用药对既往单纯放疗失败或既往放疗加亚硝基脲类化疗失败的复发性恶性胶质瘤患者的疗效。
对77例复发性恶性胶质瘤患者进行研究。在洛莫司汀给药前4天给予6-硫鸟嘌呤，在洛莫司汀给药前1天及给药后2天给予丙卡巴肼以增强洛莫司汀的抗肿瘤作用。羟基脲在洛莫司汀给药前1天开始使用，共持续3天。
30例胶质母细胞瘤患者和47例间变性胶质瘤患者符合评估条件。在胶质母细胞瘤组中，30例患者中有2例部分缓解，8例病情稳定。这组有反应和病情稳定的患者中，10例未接受过先前化疗的患者中有6例，而20例接受过先前化疗的患者中只有4例。胶质母细胞瘤组疾病进展的总体中位时间为9周。在间变性胶质瘤组中，47例患者中有11例部分缓解，25例病情稳定，其中30例未接受过先前化疗的患者中有23例，17例接受过先前化疗的患者中有13例。整个间变性胶质瘤组疾病进展的中位时间为24周；然而，未接受过先前化疗的有反应患者疾病进展时间为50周，接受过先前化疗的患者为25周。
我们的结果表明，6-硫鸟嘌呤、丙卡巴肼、洛莫司汀和羟基脲联合化疗对既往未接受亚硝基脲类化疗的复发性间变性胶质瘤和胶质母细胞瘤患者有效，但对既往接受过化疗的胶质母细胞瘤患者无效。
