Difference between revisions of "Low-grade glioma"
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Revision as of 23:21, 26 December 2017
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7 regimens on this page
10 variants on this page
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Guidelines
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
Adjuvant therapy
Radiation therapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Shaw et al. 2012 (RTOG 9802) | Phase III | RT, then PCV | Inferior PFS |
Baumert et al. 2016 (EORTC 22033-26033) | Phase III | Temozolomide | Seems not superior |
Used as a comparator arm; see references for details.
References
- 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. link to original article contains verified protocol link to PMC article PubMed
- 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. link to original article contains protocol link to PMC article PubMed
RT, then PCV
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RT, then PCV: Radiation Therapy followed by Procarbazine, CCNU (Lomustine), Vincristine
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Shaw et al. 2012 (RTOG 9802) | Phase III | Radiotherapy | Superior PFS |
Radiotherapy
- Radiation therapy with 1.8 Gy fractions given in 30 fractions over 6 weeks, for a total dose of 54 Gy
One course, followed by:
Chemotherapy
- Procarbazine (Matulane) 60 mg/m2 PO once per day on days 8 to 21
- Lomustine (Ceenu) 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
- 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. link to original article contains verified protocol link to PMC article PubMed
Temozolomide monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Baumert et al. 2016 (EORTC 22033-26033) | Phase III | Radiotherapy | Seems not superior |
Chemotherapy
- Temozolomide (Temodar) 75 mg/m2 once per day on days 1 to 21
28-day cycle for up to 12 cycles
References
- 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. link to original article contains protocol link to PMC article PubMed
Recurrent or progressive, non-curative therapy
Carboplatin monotherapy
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Regimen
Study | Evidence |
---|---|
Moghrabi et al. 1998 | Phase II |
Chemotherapy
- Carboplatin (Paraplatin) 560 mg/m2 IV over 1 hour once on day 1
- Mixed in D5 1/2 NS
Supportive medications
- 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, given until progression of disease, or unacceptable toxicity
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 verified protocol PubMed
Carboplatin & Teniposide
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Regimen
Study | Evidence |
---|---|
Brandes et al. 2003 | Phase II |
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 medications
- 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 verified protocol PubMed
Cisplatin & Etoposide
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Regimen
Study | Evidence |
---|---|
Massimino et al. 2010 | Non-randomized |
Note: In children less than 1 year old or less than 10 kg, "doses were adjusted to their weight"--reference does not say exactly how doses are adjusted.
Chemotherapy
- Cisplatin (Platinol) 25 mg/m2 IV over 2 hours once per day on days 1 to 3, given first
- Etoposide (Vepesid) 100 mg/m2 IV over 30 minutes once per day on days 1 to 3, given second
Supportive medications
- Hydration for 2 hours before chemotherapy, and for 2 hours after chemotherapy
28-day cycle for 4 cycles, then 35-day cycle for 3 cycles, then 42-day cycle for 3 cycles
References
- Massimino M, Spreafico F, Riva D, Biassoni V, Poggi G, Solero C, Gandola L, Genitori L, Modena P, Simonetti F, Potepan P, Casanova M, Meazza C, Clerici CA, Catania S, Sardi I, Giangaspero F. A lower-dose, lower-toxicity cisplatin-etoposide regimen for childhood progressive low-grade glioma. J Neurooncol. 2010 Oct;100(1):65-71. Epub 2010 Feb 12. link to original article contains verified protocol PubMed
PCV
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PCV: Procarbazine, CCNU (Lomustine), Vincristine
Regimen
Study | Evidence |
---|---|
Brandes et al. 2004 | Phase II |
Chemotherapy
- Procarbazine (Matulane) 60 mg/m2 PO once per day on days 8 to 21
- Lomustine (Ceenu) 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 medications
- 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 verified protocol PubMed
- 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
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Regimen #1, low dose
Study | Evidence |
---|---|
Pouratian et al. 2006 | Retrospective |
Chemotherapy
- Temozolomide (Temodar) 75 mg/m2 PO once per day on days 1 to 21
Supportive medications
- PCP prophylaxis with Trimethoprim/Sulfamethoxazole (Bactrim)
- Antiemetics and stool softeners used as needed
28-day cycle for 12 to 15 cycles
Regimen #2, low dose, longer cycles
Study | Evidence |
---|---|
Kesari et al. 2009 | Phase II |
Chemotherapy
- Temozolomide (Temodar) 75 mg/m2 PO once per day on days 1 to 49
Supportive medications
- PCP prophylaxis with Trimethoprim/Sulfamethoxazole (Bactrim)
77-day cycle for up to 6 cycles, progression of disease, or unacceptable toxicity
Regimen #3, traditional initial dosing, then continuous therapy
Study | Evidence |
---|---|
Perry et al. 2008 (RESCUE) | Phase II |
At first recurrence/progression:
Chemotherapy
- Temozolomide (Temodar) 150 to 200 mg/m2 PO once per day on days 1 to 5
28-day cycles
Patients with progressive disease are changed to:
- Temozolomide (Temodar) 50 mg/m2 PO once per day, taken continuously without treatment break
Given until progression of disease or unacceptable toxicity
Regimen #4, traditional dosing
Study | Evidence |
---|---|
Chinot et al. 2001 | Phase II |
Nicholson et al. 2007 | Non-randomized |
Chemotherapy
- Temozolomide (Temodar) 200 mg/m2 PO once per day on days 1 to 5
- In Nicholson et al. 2007, patients who previously received craniospinal irradiation (CSI) instead received 180 mg/m2 PO once per day on days 1 to 5
28-day cycle for up to 24 months (in Chinot et al. 2001) or 11 cycles (in Nicholson et al. 2007)
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 verified protocol PubMed
- 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 verified protocol PubMed
- Nicholson HS, Kretschmar CS, Krailo M, Bernstein M, Kadota R, Fort D, Friedman H, Harris MB, Tedeschi-Blok N, Mazewski C, Sato J, Reaman GH. Phase 2 study of temozolomide in children and adolescents with recurrent central nervous system tumors: a report from the Children's Oncology Group. Cancer. 2007 Oct 1;110(7):1542-50. link to original article contains verified protocol PubMed
- 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 verified protocol 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. link to original article contains verified protocol 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 verified protocol PubMed