Fukushima T, Yamamoto M, Ikeda K, Tsugu H, Kimura H, Soma G, Tomonaga M
Department of Neurosurgery, Fukuoka University School of Medicine, Japan.
Anticancer Res. 1998 Sep-Oct;18(5D):3965-70.
We present our experience with a combination chemotherapy regimen consisting of ranimustine (MCNU) and recombinant human mutant tumor necrosis factor-alpha (TNF-SAM2) for malignant astrocytomas. The initial regimens were prescribed as adjuvant therapy in conjunction with radiotherapy following standard surgical treatment. Newly diagnosed patients were treated with up to four cycles of this regimen (TNF-SAM2, MCNU, and radiotherapy: TMR group). Seventeen patients (11 men and 6 women) aged 24 to 68 years (median 54.6 years) were eligible and evaluated for response and toxicity. The estimated median survival time was 354 weeks with anaplastic astrocytomas, and 76 weeks with glioblastomas. One- and 2-year survival rates were 100% and 100% with anaplastic astrocytomas, and 69.2% and 29.7% with glioblastomas. Grade 3 and 4 hematological toxicities were not experienced. None of the patients experienced a treatment delay due to toxicity. All other acute toxicities were anticipated and manageable. Twenty three patients (11 men and 12 women) aged 22 to 66 years (median 50.7 years) were evaluated as a historical control of patients who received chemotherapy with MCNU alone in conjunction with radiotherapy following standard surgical treatment (MCNU and radiotherapy: MR group). The estimated median survival time was 205 weeks with anaplastic astrocytomas, and 62 weeks with glioblastomas. One- and 2-year survival rates were 88.9% and 66.7% with anaplastic astrocytomas, and 71.4% and 7.1% with glioblastomas in this group. There were no significant differences in survival rates between patients in the TMR and MR groups with either anaplastic astrocytoma or glioblastoma. However, despite the small number of patients, those with anaplastic astrocytoma in the TMR group tended to survive longer than those in the MR group. These results suggest that combined chemotherapy with mutant TNF-alpha may benefit those with anaplastic astrocytoma, and thus warrants further evaluation. On the other hand, the lack of activity does not warrant any further study of this schedule of TNF-SAM2 for the treatment of glioblastoma.
我们介绍了使用雷莫司汀（MCNU）和重组人突变型肿瘤坏死因子-α（TNF-SAM2）联合化疗方案治疗恶性星形细胞瘤的经验。初始方案在标准手术治疗后作为辅助治疗与放疗联合使用。新诊断的患者接受该方案最多四个周期的治疗（TNF-SAM2、MCNU和放疗：TMR组）。17例年龄在24至68岁（中位年龄54.6岁）的患者（11例男性和6例女性）符合条件，并对其反应和毒性进行了评估。间变性星形细胞瘤的估计中位生存时间为354周，胶质母细胞瘤为76周。间变性星形细胞瘤的1年和2年生存率分别为100%和100%，胶质母细胞瘤为69.2%和29.7%。未出现3级和4级血液学毒性。没有患者因毒性而出现治疗延迟。所有其他急性毒性均在预期范围内且可控。23例年龄在22至66岁（中位年龄50.7岁）的患者（11例男性和12例女性）被评估为历史对照组，这些患者在标准手术治疗后仅接受MCNU化疗联合放疗（MCNU和放疗：MR组）。间变性星形细胞瘤的估计中位生存时间为205周，胶质母细胞瘤为62周。该组中间变性星形细胞瘤的1年和2年生存率分别为88.9%和66.7%，胶质母细胞瘤为71.4%和7.1%。TMR组和MR组间变性星形细胞瘤或胶质母细胞瘤患者的生存率没有显著差异。然而，尽管患者数量较少，但TMR组中间变性星形细胞瘤患者的生存时间往往比MR组更长。这些结果表明，突变型TNF-α联合化疗可能使间变性星形细胞瘤患者受益，因此值得进一步评估。另一方面，如果缺乏活性，则没有必要对该TNF-SAM2方案用于治疗胶质母细胞瘤进行进一步研究。
