Difference between revisions of "Low-grade glioma"
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[[#top|Back to Top]] | [[#top|Back to Top]] | ||
</div> | </div> | ||
− | { | + | {{#lst:Editorial board transclusions|neuro}} |
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''Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit [[Low-grade glioma - null regimens|this page]]. If you still can't find it, please let us know so we can add it!''<br> | ''Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit [[Low-grade glioma - null regimens|this page]]. If you still can't find it, please let us know so we can add it!''<br> | ||
<big>'''Note: pediatric regimens have been moved to a dedicated page: | <big>'''Note: pediatric regimens have been moved to a dedicated page: | ||
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
=Guidelines= | =Guidelines= | ||
+ | '''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.''' | ||
==EANO== | ==EANO== | ||
− | *[https://doi.org/10.1016/S1470-2045(17)30194-8 European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas (2017)] [https://pubmed.ncbi.nlm.nih.gov/28483413 PubMed] | + | *[https://doi.org/10.1016/S1470-2045(17)30194-8 European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas (2017)] [https://pubmed.ncbi.nlm.nih.gov/28483413/ PubMed] |
− | *[https://doi.org/10.1016/S1470-2045(17)30345-5 European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma (2017)] [https://pubmed.ncbi.nlm.nih.gov/28593859 PubMed] | + | *[https://doi.org/10.1016/S1470-2045(17)30345-5 European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma (2017)] [https://pubmed.ncbi.nlm.nih.gov/28593859/ PubMed] |
− | == | + | ==NCCN== |
− | *[https://www.nccn.org/ | + | *''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1425 NCCN Guidelines - Central Nervous System Cancers].'' |
+ | |||
=Adjuvant therapy= | =Adjuvant therapy= | ||
==PCV {{#subobject:768bb0|Regimen=1}}== | ==PCV {{#subobject:768bb0|Regimen=1}}== | ||
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{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
!style="width: 20%"|Study | !style="width: 20%"|Study | ||
− | !style="width: 20%"| | + | !style="width: 20%"|Dates of enrollment |
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 20%"|Comparator | !style="width: 20%"|Comparator | ||
Line 42: | Line 38: | ||
|style="background-color:#1a9851"|Phase 3 (E-esc) | |style="background-color:#1a9851"|Phase 3 (E-esc) | ||
|[[Low-grade_glioma_-_null_regimens#Observation|Observation]] | |[[Low-grade_glioma_-_null_regimens#Observation|Observation]] | ||
− | |style="background-color:#1a9850"|Superior OS<sup>1</sup> | + | |style="background-color:#1a9850"|Superior OS<sup>1</sup> (primary endpoint)<br>Median OS: 13.3 vs 7.8 y<br>(HR 0.59) |
|- | |- | ||
|} | |} | ||
Line 48: | Line 44: | ||
<div class="toccolours" style="background-color:#cbd5e8"> | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
− | *[[#Radiation_therapy|RT]] x | + | *Definitive [[#Radiation_therapy|RT]] x 5400 cGy |
</div> | </div> | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
Line 57: | Line 53: | ||
'''8-week cycle for 6 cycles''' | '''8-week cycle for 6 cycles''' | ||
</div></div> | </div></div> | ||
+ | |||
===References=== | ===References=== | ||
− | # '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558 PubMed] NCT00003375 | + | # '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558/ PubMed] [https://clinicaltrials.gov/study/NCT00003375 NCT00003375] |
− | ## '''Update:''' Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206 PubMed] | + | ## '''Update:''' Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206/ PubMed] |
==Radiation therapy {{#subobject:ae4089|Regimen=1}}== | ==Radiation therapy {{#subobject:ae4089|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
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{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
!style="width: 20%"|Study | !style="width: 20%"|Study | ||
− | !style="width: 20%"| | + | !style="width: 20%"|Dates of enrollment |
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 20%"|Comparator | !style="width: 20%"|Comparator | ||
Line 72: | Line 69: | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ Shaw et al. 2012 (RTOG 9802)] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ Shaw et al. 2012 (RTOG 9802)] | ||
|1998-2002 | |1998-2002 | ||
− | |style="background-color:#91cf61"|Non-randomized | + | |style="background-color:#91cf61"|Non-randomized part of phase 3 RCT |
|style="background-color:#d3d3d3"| | |style="background-color:#d3d3d3"| | ||
|style="background-color:#d3d3d3"| | |style="background-color:#d3d3d3"| | ||
Line 86: | Line 83: | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
− | *[[External beam radiotherapy]] with | + | *[[External beam radiotherapy]] with 180 cGy fractions given in 30 fractions, for a total dose of 5400 cGy |
'''6-week course''' | '''6-week course''' | ||
</div> | </div> | ||
<div class="toccolours" style="background-color:#cbd5e7"> | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
− | *RTOG 9802: [[Low-grade_glioma_-_null_regimens#Observation|Observation]] versus [[#PCV|PCV]] x 6 | + | *RTOG 9802: [[Low-grade_glioma_-_null_regimens#Observation|Observation]] versus adjuvant [[#PCV|PCV]] x 6 |
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558 PubMed] NCT00003375 | + | # '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558/ PubMed] [https://clinicaltrials.gov/study/NCT00003375 NCT00003375] |
− | ## '''Update:''' Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206 PubMed] | + | ## '''Update:''' Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206/ PubMed] |
− | # '''EORTC 22033-26033:''' Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946 PubMed] NCT00182819 | + | # '''EORTC 22033-26033:''' Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. Epub 2016 Sep 27. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946/ PubMed] [https://clinicaltrials.gov/study/NCT00182819 NCT00182819] |
− | #'''ECOG E3F05:''' NCT00978458 | + | #'''ECOG E3F05:''' [https://clinicaltrials.gov/study/NCT00978458 NCT00978458] |
==Temozolomide monotherapy {{#subobject:31d3b0|Regimen=1}}== | ==Temozolomide monotherapy {{#subobject:31d3b0|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
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{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
!style="width: 20%"|Study | !style="width: 20%"|Study | ||
− | !style="width: 20%"| | + | !style="width: 20%"|Dates of enrollment |
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 20%"|Comparator | !style="width: 20%"|Comparator | ||
Line 121: | Line 118: | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # '''EORTC 22033-26033:''' Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946 PubMed] NCT00182819 | + | # '''EORTC 22033-26033:''' Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. Epub 2016 Sep 27. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946/ PubMed] [https://clinicaltrials.gov/study/NCT00182819 NCT00182819] |
=Recurrent or progressive, non-curative therapy= | =Recurrent or progressive, non-curative therapy= | ||
==Carboplatin monotherapy {{#subobject:e18c52|Regimen=1}}== | ==Carboplatin monotherapy {{#subobject:e18c52|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:24c607|Variant=1}}=== | ===Regimen {{#subobject:24c607|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.3171/foc.1998.4.4.6 Moghrabi et al. 1998] |
+ | |NR | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 143: | Line 142: | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, Bruggers C, Provenzale JM, Champagne M, Hershon L, Watral M, Ryan J, Rasheed K, Lovell S, Korones D, Fuchs H, George T, McLendon RE, Friedman AH, Buckley E, Longee DC. Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus. 1998 Apr 15;4(4):e3. [ | + | # Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, Bruggers C, Provenzale JM, Champagne M, Hershon L, Watral M, Ryan J, Rasheed K, Lovell S, Korones D, Fuchs H, George T, McLendon RE, Friedman AH, Buckley E, Longee DC. Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus. 1998 Apr 15;4(4):e3. [https://doi.org/10.3171/foc.1998.4.4.6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17168503/ PubMed] |
+ | |||
==Carboplatin & Teniposide {{#subobject:b10263|Regimen=1}}== | ==Carboplatin & Teniposide {{#subobject:b10263|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:531596|Variant=1}}=== | ===Regimen {{#subobject:531596|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1093/annonc/mdg494 Brandes et al. 2003] | |[https://doi.org/10.1093/annonc/mdg494 Brandes et al. 2003] | ||
+ | |1994-01 to 2002-12 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 166: | Line 168: | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # Brandes AA, Basso U, Vastola F, Tosoni A, Pasetto LM, Jirillo A, Lonardi S, Paris MK, Koussis H, Monfardini S, Ermani M. Carboplatin and teniposide as third-line chemotherapy in patients with recurrent oligodendroglioma or oligoastrocytoma: a phase II study. Ann Oncol. 2003 Dec;14(12):1727-31. [https://doi.org/10.1093/annonc/mdg494 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14630676 PubMed] | + | # Brandes AA, Basso U, Vastola F, Tosoni A, Pasetto LM, Jirillo A, Lonardi S, Paris MK, Koussis H, Monfardini S, Ermani M. Carboplatin and teniposide as third-line chemotherapy in patients with recurrent oligodendroglioma or oligoastrocytoma: a phase II study. Ann Oncol. 2003 Dec;14(12):1727-31. [https://doi.org/10.1093/annonc/mdg494 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14630676/ PubMed] |
==PCV {{#subobject:7e7af0|Regimen=1}}== | ==PCV {{#subobject:7e7af0|Regimen=1}}== | ||
PCV: '''<u>P</u>'''rocarbazine, '''<u>C</u>'''CNU (Lomustine), '''<u>V</u>'''incristine | PCV: '''<u>P</u>'''rocarbazine, '''<u>C</u>'''CNU (Lomustine), '''<u>V</u>'''incristine | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:6c3103|Variant=1}}=== | ===Regimen {{#subobject:6c3103|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1002/cncr.20611 Brandes et al. 2004] | |[https://doi.org/10.1002/cncr.20611 Brandes et al. 2004] | ||
+ | |1994-11 to 2000-09 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 190: | Line 194: | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # Brandes AA, Tosoni A, Vastola F, Pasetto LM, Coria B, Danieli D, Iuzzolino P, Gardiman M, Talacchi A, Ermani M. Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy: a phase II study. Cancer. 2004 Nov 1;101(9):2079-85. [https://doi.org/10.1002/cncr.20611 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15372474 PubMed] | + | # Brandes AA, Tosoni A, Vastola F, Pasetto LM, Coria B, Danieli D, Iuzzolino P, Gardiman M, Talacchi A, Ermani M. Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy: a phase II study. Cancer. 2004 Nov 1;101(9):2079-85. [https://doi.org/10.1002/cncr.20611 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15372474/ PubMed] |
− | # '''Retrospective:''' Triebels VH, Taphoorn MJ, Brandes AA, Menten J, Frenay M, Tosoni A, Kros JM, Stege EB, Enting RH, Allgeier A, van Heuvel I, van den Bent MJ. Salvage PCV chemotherapy for temozolomide-resistant oligodendrogliomas. Neurology. 2004 Sep 14;63(5):904-6. [ | + | # '''Retrospective:''' Triebels VH, Taphoorn MJ, Brandes AA, Menten J, Frenay M, Tosoni A, Kros JM, Stege EB, Enting RH, Allgeier A, van Heuvel I, van den Bent MJ. Salvage PCV chemotherapy for temozolomide-resistant oligodendrogliomas. Neurology. 2004 Sep 14;63(5):904-6. [https://doi.org/10.1212/01.wnl.0000137049.65631.db link to original article] [https://pubmed.ncbi.nlm.nih.gov/15365146/ PubMed] |
==Temozolomide monotherapy {{#subobject:7b66b|Regimen=1}}== | ==Temozolomide monotherapy {{#subobject:7b66b|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #1, low dose {{#subobject:863ec|Variant=1}}=== | ===Regimen variant #1, low dose {{#subobject:863ec|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1007/s11060-006-9280-4 Pouratian et al. 2006] | |[https://doi.org/10.1007/s11060-006-9280-4 Pouratian et al. 2006] | ||
+ | |2003-10 to 2006-06 | ||
|style="background-color:#ffffbe"|Retrospective | |style="background-color:#ffffbe"|Retrospective | ||
|- | |- | ||
Line 213: | Line 219: | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #2, low dose, longer cycles {{#subobject:50fd6b|Variant=1}}=== | ===Regimen variant #2, low dose, longer cycles {{#subobject:50fd6b|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1158/1078-0432.CCR-08-0888 Kesari et al. 2009] | |[https://doi.org/10.1158/1078-0432.CCR-08-0888 Kesari et al. 2009] | ||
+ | |NR | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 230: | Line 238: | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #3, continuous therapy {{#subobject:3871fe|Variant=1}}=== | ===Regimen variant #3, continuous therapy {{#subobject:3871fe|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1002/cncr.23813 Perry et al. 2008 (RESCUE)] | |[https://doi.org/10.1002/cncr.23813 Perry et al. 2008 (RESCUE)] | ||
+ | |2001-01 to 2005-07 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 240: | Line 250: | ||
<div class="toccolours" style="background-color:#cbd5e8"> | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
− | *Conventional [[#Temozolomide_monotherapy|temozolomide]], with progression | + | *Conventional adjuvant [[#Temozolomide_monotherapy|temozolomide]], with progression |
</div> | </div> | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
Line 248: | Line 258: | ||
</div></div><br> | </div></div><br> | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | |||
===Regimen variant #4, traditional dosing {{#subobject:4fe632|Variant=1}}=== | ===Regimen variant #4, traditional dosing {{#subobject:4fe632|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.2001.19.9.2449 Chinot et al. 2001] | |[https://doi.org/10.1200/jco.2001.19.9.2449 Chinot et al. 2001] | ||
+ | |1995-04 to 1999-07 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 263: | Line 276: | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, Braguer D, Martin PM, Grisoli F. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001 May 1;19(9):2449-55. [https://doi.org/10.1200/jco.2001.19.9.2449 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11331324 PubMed] | + | # Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, Braguer D, Martin PM, Grisoli F. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001 May 1;19(9):2449-55. [https://doi.org/10.1200/jco.2001.19.9.2449 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11331324/ PubMed] |
− | # '''Retrospective:''' Pouratian N, Gasco J, Sherman JH, Shaffrey ME, Schiff D. Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol. 2007 May;82(3):281-8. Epub 2006 Nov 3. [https://doi.org/10.1007/s11060-006-9280-4 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17082887 PubMed] | + | # '''Retrospective:''' Pouratian N, Gasco J, Sherman JH, Shaffrey ME, Schiff D. Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol. 2007 May;82(3):281-8. Epub 2006 Nov 3. [https://doi.org/10.1007/s11060-006-9280-4 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17082887/ PubMed] |
− | # '''RESCUE:''' Perry JR, Rizek P, Cashman R, Morrison M, Morrison T. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the "rescue" approach. Cancer. 2008 Oct 15;113(8):2152-7. [https://doi.org/10.1002/cncr.23813 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/18756530 PubMed] NCT00392171 | + | # '''RESCUE:''' Perry JR, Rizek P, Cashman R, Morrison M, Morrison T. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the "rescue" approach. Cancer. 2008 Oct 15;113(8):2152-7. [https://doi.org/10.1002/cncr.23813 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/18756530/ PubMed] [https://clinicaltrials.gov/study/NCT00392171 NCT00392171] |
− | ## '''Update:''' Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol. 2010 Apr 20;28(12):2051-7. Epub 2010 Mar 22. [https://doi.org/10.1200/jco.2009.26.5520 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/20308655 PubMed] | + | ## '''Update:''' Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol. 2010 Apr 20;28(12):2051-7. Epub 2010 Mar 22. [https://doi.org/10.1200/jco.2009.26.5520 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/20308655/ PubMed] |
− | # Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res. 2009 Jan 1;15(1):330-7. [https://doi.org/10.1158/1078-0432.CCR-08-0888 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19118062 PubMed] | + | # Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res. 2009 Jan 1;15(1):330-7. [https://doi.org/10.1158/1078-0432.CCR-08-0888 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19118062/ PubMed] |
[[Category:Low-grade glioma regimens]] | [[Category:Low-grade glioma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Low-grade gliomas]] | [[Category:Low-grade gliomas]] |
Latest revision as of 02:03, 2 July 2024
Section editor | |
---|---|
Seema Nagpal, MD Stanford University Palo Alto, CA, USA |
Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit this page. If you still can't find it, please let us know so we can add it!
Note: pediatric regimens have been moved to a dedicated page:
7 regimens on this page
10 variants on this page
|
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
EANO
- European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas (2017) PubMed
- European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma (2017) PubMed
NCCN
- NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Central Nervous System Cancers.
Adjuvant therapy
PCV
PCV: Procarbazine, CCNU (Lomustine), Vincristine
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Shaw et al. 2012 (RTOG 9802) | 1998-2002 | Phase 3 (E-esc) | Observation | Superior OS1 (primary endpoint) Median OS: 13.3 vs 7.8 y (HR 0.59) |
1Reported efficacy is based on the 2016 update.
Preceding treatment
- Definitive RT x 5400 cGy
Chemotherapy
- Procarbazine (Matulane) 60 mg/m2 PO once per day on days 8 to 21
- Lomustine (CCNU) 110 mg/m2 PO once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 8 & 29
8-week cycle for 6 cycles
References
- RTOG 9802: Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00003375
- Update: Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. link to original article link to PMC article PubMed
Radiation therapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Shaw et al. 2012 (RTOG 9802) | 1998-2002 | Non-randomized part of phase 3 RCT | ||
Baumert et al. 2016 (EORTC 22033-26033) | 2005-2010 | Phase 3 (C) | Temozolomide | Did not meet primary endpoint of PFS |
Note: Details here are from RTOG 9802.
Radiotherapy
- External beam radiotherapy with 180 cGy fractions given in 30 fractions, for a total dose of 5400 cGy
6-week course
Subsequent treatment
- RTOG 9802: Observation versus adjuvant PCV x 6
References
- RTOG 9802: Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00003375
- Update: Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. link to original article link to PMC article PubMed
- EORTC 22033-26033: Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. Epub 2016 Sep 27. link to original article contains dosing details in abstract link to PMC article PubMed NCT00182819
- ECOG E3F05: NCT00978458
Temozolomide monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Baumert et al. 2016 (EORTC 22033-26033) | 2005-2010 | Phase 3 (E-switch-ooc) | Radiotherapy | Did not meet primary endpoint of PFS |
Chemotherapy
- Temozolomide (Temodar) 75 mg/m2 PO once per day on days 1 to 21
28-day cycle for up to 12 cycles
References
- EORTC 22033-26033: Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. Epub 2016 Sep 27. link to original article contains dosing details in abstract link to PMC article PubMed NCT00182819
Recurrent or progressive, non-curative therapy
Carboplatin monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Moghrabi et al. 1998 | NR | Phase 2 |
Chemotherapy
- Carboplatin (Paraplatin) 560 mg/m2 IV over 60 minutes once on day 1
- Mixed in D5 1/2 NS
Supportive therapy
- Hydration for 1 hour before chemotherapy, and for 1 hour after chemotherapy; total volume including carboplatin is 900 mL/m2
28-day cycle for up to 12 cycles beyond the maximum response
References
- Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, Bruggers C, Provenzale JM, Champagne M, Hershon L, Watral M, Ryan J, Rasheed K, Lovell S, Korones D, Fuchs H, George T, McLendon RE, Friedman AH, Buckley E, Longee DC. Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus. 1998 Apr 15;4(4):e3. link to original article contains dosing details in manuscript PubMed
Carboplatin & Teniposide
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Brandes et al. 2003 | 1994-01 to 2002-12 | Phase 2 |
Chemotherapy
- Carboplatin (Paraplatin) 350 mg/m2 IV once on day 1
- Teniposide (Vumon) 50 mg/m2 IV once per day on days 1 to 3
Supportive therapy
- Prophylactic 5-HT3 antagonists routinely used
- Lowest dose of corticosteroids necessary to maintain neurologic stability
- Antiepileptic medications for all patients
28-day cycle for up to 10 cycles
References
- Brandes AA, Basso U, Vastola F, Tosoni A, Pasetto LM, Jirillo A, Lonardi S, Paris MK, Koussis H, Monfardini S, Ermani M. Carboplatin and teniposide as third-line chemotherapy in patients with recurrent oligodendroglioma or oligoastrocytoma: a phase II study. Ann Oncol. 2003 Dec;14(12):1727-31. link to original article contains dosing details in manuscript PubMed
PCV
PCV: Procarbazine, CCNU (Lomustine), Vincristine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Brandes et al. 2004 | 1994-11 to 2000-09 | Phase 2 |
Chemotherapy
- Procarbazine (Matulane) 60 mg/m2 PO once per day on days 8 to 21
- Lomustine (CCNU) 110 mg/m2 PO once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 8 & 29
Supportive therapy
- Routine use of prophylactic 5-HT3 antagonists
- Steroids given at the lowest dose required by patient's neurologic status
42-day cycle for up to 6 cycles
References
- Brandes AA, Tosoni A, Vastola F, Pasetto LM, Coria B, Danieli D, Iuzzolino P, Gardiman M, Talacchi A, Ermani M. Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy: a phase II study. Cancer. 2004 Nov 1;101(9):2079-85. link to original article contains dosing details in manuscript PubMed
- Retrospective: Triebels VH, Taphoorn MJ, Brandes AA, Menten J, Frenay M, Tosoni A, Kros JM, Stege EB, Enting RH, Allgeier A, van Heuvel I, van den Bent MJ. Salvage PCV chemotherapy for temozolomide-resistant oligodendrogliomas. Neurology. 2004 Sep 14;63(5):904-6. link to original article PubMed
Temozolomide monotherapy
Regimen variant #1, low dose
Study | Dates of enrollment | Evidence |
---|---|---|
Pouratian et al. 2006 | 2003-10 to 2006-06 | Retrospective |
Chemotherapy
- Temozolomide (Temodar) 75 mg/m2 PO once per day on days 1 to 21
Supportive therapy
- PCP prophylaxis with Trimethoprim/Sulfamethoxazole (Bactrim)
- Antiemetics and stool softeners used as needed
28-day cycle for 12 to 15 cycles
Regimen variant #2, low dose, longer cycles
Study | Dates of enrollment | Evidence |
---|---|---|
Kesari et al. 2009 | NR | Phase 2 |
Chemotherapy
- Temozolomide (Temodar) 75 mg/m2 PO once per day on days 1 to 49
Supportive therapy
- PCP prophylaxis with Trimethoprim/Sulfamethoxazole (Bactrim)
77-day cycle for up to 6 cycles
Regimen variant #3, continuous therapy
Study | Dates of enrollment | Evidence |
---|---|---|
Perry et al. 2008 (RESCUE) | 2001-01 to 2005-07 | Phase 2 |
Preceding treatment
- Conventional adjuvant temozolomide, with progression
Regimen variant #4, traditional dosing
Study | Dates of enrollment | Evidence |
---|---|---|
Chinot et al. 2001 | 1995-04 to 1999-07 | Phase 2 |
Chemotherapy
- Temozolomide (Temodar) 200 mg/m2 PO once per day on days 1 to 5
28-day cycle for up to 26 cycles (2 years)
References
- Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, Braguer D, Martin PM, Grisoli F. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001 May 1;19(9):2449-55. link to original article contains dosing details in manuscript PubMed
- Retrospective: Pouratian N, Gasco J, Sherman JH, Shaffrey ME, Schiff D. Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol. 2007 May;82(3):281-8. Epub 2006 Nov 3. link to original article contains dosing details in manuscript PubMed
- RESCUE: Perry JR, Rizek P, Cashman R, Morrison M, Morrison T. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the "rescue" approach. Cancer. 2008 Oct 15;113(8):2152-7. link to original article contains dosing details in manuscript PubMed NCT00392171
- Update: Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol. 2010 Apr 20;28(12):2051-7. Epub 2010 Mar 22. link to original article contains dosing details in manuscript PubMed
- Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res. 2009 Jan 1;15(1):330-7. link to original article contains dosing details in manuscript PubMed