J Korean Neurosurg Soc.  2013 Dec;54(6):489-495. 10.3340/jkns.2013.54.6.489.

Temozolomide Salvage Chemotherapy for Recurrent Anaplastic Oligodendroglioma and Oligo-Astrocytoma

• Gwak HS
• Yee GT
• Park CK
• Kim JW
• Hong YK
• Kang SG
• Kim JH
• Seol HJ
• Jung TY
• Chang JH
• Yoo H
• Hwang JH
• Kim SH
• Park BJ
• Hwang SC
• Kim MS
• Kim SH
• Kim EY
• Kim E
• Kim HY
• Ko YC
• Yun HJ
• Youn JH
• Kim J
• Lee B
• Lee SH

• KMID: 2190944
• DOI: http://doi.org/10.3340/jkns.2013.54.6.489

Abstract

OBJECTIVE
To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA).
METHODS
A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 mg/m2/day) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed.
RESULTS
TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (> or =grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient's histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01).
CONCLUSION
For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.

Keyword

Anaplastic oligodendroglioma; Anaplastic oligoastrocytoma; Chemotherapy; Recurrence; Temozolomide

MeSH Terms

Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Lomustine
Oligodendroglioma*
Procarbazine
Recurrence
Retrospective Studies
Salvage Therapy
Vincristine
Lomustine
Procarbazine
Vincristine

Figure

• 

  Fig. 1 Kaplan-Meier progression-free survival in patients with recurrent AO or AOA after salvage TMZ chemotherapy (A) according to histopathology (AO vs. SOA, p>0.05) and (B) time to recurrence after the initial treatment for AO/AOA (<1 year vs. ≥1 year, p=0.04). AO : anaplastic oligodendroglioma, AOA : anaplastic oligo-astrocytoma, TMZ : temozolomide.

• 

  Fig. 2 Kaplan-Meier overall survival in patients with recurrent AO or AOA after salvage TMZ chemotherapy (A) according to histopathology (AO vs. AOA, p>0.05) and (B) ECOG performance status (0-1 vs. 2-3, p=0.007). AO : anaplastic oligodendroglioma, AOA : anaplastic oligo-astrocytoma, TMZ : temozolomide.

Reference

1. Balmaceda C, Peereboom D, Pannullo S, Cheung YK, Fisher PG, Alavi J, et al. Multi-institutional phase II study of temozolomide administered twice daily in the treatment of recurrent high-grade gliomas. Cancer. 2008; 112:1139–1146. PMID: 18246536.

2. Brada M, Hoang-Xuan K, Rampling R, Dietrich PY, Dirix LY, Macdonald D, et al. Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol. 2001; 12:259–266. PMID: 11300335.

3. Brandes AA, Tosoni A, Cavallo G, Reni M, Franceschi E, Bonaldi L, et al. Correlations between O6-methylguanine DNA methyltransferase promoter methylation status, 1p and 19q deletions, and response to temozolomide in anaplastic and recurrent oligodendroglioma : a prospective GICNO study. J Clin Oncol. 2006; 24:4746–4753. PMID: 16954518.

4. Brandes AA, Tosoni A, Vastola F, Pasetto LM, Coria B, Danieli D, et al. Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy. A Phase II study. Cancer. 2004; 101:2079–2085. PMID: 15372474.

5. Cairncross G, Berkey B, Shaw E, Jenkins R, Scheithauer B, Brachman D, et al. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma : Intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol. 2006; 24:2707–2714. PMID: 16782910.

6. Cairncross G, Macdonald D, Ludwin S, Lee D, Cascino T, Buckner J, et al. National Cancer Institute of Canada Clinical Trials Group. Chemotherapy for anaplastic oligodendroglioma. J Clin Oncol. 1994; 12:2013–2021. PMID: 7931469.

7. Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, et al. Phase III Trial of Chemoradiotherapy for Anaplastic Oligodendroglioma : Long-Term Results of RTOG 9402. J Clin Oncol. 2013; 31:337–343. PMID: 23071247.

8. Chamberlain MC, Glantz MJ. CPT-11 for recurrent temozolomide-refractory 1p19q co-deleted anaplastic oligodendroglioma. J Neurooncol. 2008; 89:231–238. PMID: 18480965.

9. Chamberlain MC, Johnston S. Bevacizumab for recurrent alkylator-refractory anaplastic oligodendroglioma. Cancer. 2009; 115:1734–1743. PMID: 19197992.

10. Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, et al. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001; 19:2449–2455. PMID: 11331324.

11. Desjardins A, Quinn JA, Vredenburgh JJ, Sathornsumetee S, Friedman AH, Herndon JE, et al. Phase II study of imatinib mesylate and hydroxyurea for recurrent grade III malignant gliomas. J Neurooncol. 2007; 83:53–60. PMID: 17245623.

12. Ducray F, del Rio MS, Carpentier C, Psimaras D, Idbaih A, Dehais C, et al. Up-front temozolomide in elderly patients with anaplastic oligodendroglioma and oligoastrocytoma. J Neurooncol. 2010; 101:457–462. PMID: 20556480.

13. Gan HK, Rosenthal MA, Dowling A, Kalnins R, Algar E, Wong N, et al. A phase II trial of primary temozolomide in patients with grade III oligodendroglial brain tumors. Neuro Oncol. 2010; 12:500–507. PMID: 20406900.

14. Gaya A, Rees J, Greenstein A, Stebbing J. The use of temozolomide in recurrent malignant gliomas. Cancer Treat Rev. 2002; 28:115–120. PMID: 12297119.

15. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990; 8:1277–1280. PMID: 2358840.

16. Macdonald DR, Gaspar LE, Cairncross JG. Successful chemotherapy for newly diagnosed aggressive oligodendroglioma. Ann Neurol. 1990; 27:573–574. PMID: 2360797.

17. Mikkelsen T, Doyle T, Anderson J, Margolis J, Paleologos N, Gutierrez J, et al. Temozolomide single-agent chemotherapy for newly diagnosed anaplastic oligodendroglioma. J Neurooncol. 2009; 92:57–63. PMID: 19011763.

18. Mohile NA, Forsyth P, Stewart D, Raizer JJ, Paleologos N, Kewalramani T, et al. A phase II study of intensified chemotherapy alone as initial treatment for newly diagnosed anaplastic oligodendroglioma : an interim analysis. J Neurooncol. 2008; 89:187–193. PMID: 18458821.

19. Newlands ES, Blackledge GR, Slack JA, Rustin GJ, Smith DB, Stuart NS, et al. Phase I trial of temozolomide CCRG 81045 : M&B 39831 : NSC 362856. Br J Cancer. 1992; 65:287–291. PMID: 1739631.

20. Noushmehr H, Weisenberger DJ, Diefes K, Phillips HS, Pujara K, Berman BP, et al. Identification of a CpG island methylator phenotype that defines a distinct subgroup of glioma. Cancer Cell. 2010; 17:510–522. PMID: 20399149.

21. Peterson K, Paleologos N, Forsyth P, Macdonald DR, Cairncross JG. Salvage chemotherapy for oligodendroglioma. J Neurosurg. 1996; 85:597–601. PMID: 8814162.

22. Pobereskin LH, Chadduck JB. Incidence of brain tumours in two English counties : a population based study. J Neurol Neurosurg Psychiatry. 2000; 69:464–471. PMID: 10990505.

23. Reifenberger G, Louis DN. Oligodendroglioma : toward molecular definitions in diagnostic neuro-oncology. J Neuropathol Exp Neurol. 2003; 62:111–126. PMID: 12578221.

24. Soffietti R, Ruda R, Bradac GB, Schiffer D. PCV chemotherapy for recurrent oligodendrogliomas and oligoastrocytomas. Neurosurgery. 1998; 43:1066–1073. PMID: 9802850.

25. Taliansky-Aronov A, Bokstein F, Lavon I, Siegal T. Temozolomide treatment for newly diagnosed anaplastic oligodendrogliomas : a clinical efficacy trial. J Neurooncol. 2006; 79:153–157. PMID: 16855865.

26. van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma : long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol. 2013; 31:344–350. PMID: 23071237.

27. van den Bent MJ, Carpentier AF, Brandes AA, Sanson M, Taphoorn MJ, Bernsen HJ, et al. Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas : a randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol. 2006; 24:2715–2722. PMID: 16782911.

28. van den Bent MJ, Chinot O, Boogerd W, Bravo Marques J, Taphoorn MJ, Kros JM, et al. Second-line chemotherapy with temozolomide in recurrent oligodendroglioma after PCV procarbazine, lomustine and vincristine chemotherapy : EORTC Brain Tumor Group phase II study 26972. Ann Oncol. 2003; 14:599–602. PMID: 12649108.

29. van den Bent MJ, Kros JM, Heimans JJ, Pronk LC, van Groeningen CJ, Krouwer HG, et al. Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-oncology Group. Neurology. 1998; 51:1140–1145. PMID: 9781544.

30. van den Bent MJ, Taphoorn MJ, Brandes AA, Menten J, Stupp R, Frenay M, et al. Phase II study of first-line chemotherapy with temozolomide in recurrent oligodendroglial tumors : the European Organization for Research and Treatment of Cancer Brain Tumor Group Study 26971. J Clin Oncol. 2003; 21:2525–2528. PMID: 12829671.

31. Yan H, Parsons DW, Jin G, McLendon R, Rasheed BA, Yuan W, et al. IDH1 and IDH2 mutations in gliomas. N Engl J Med. 2009; 360:765–773. PMID: 19228619.

32. Yang SH, Kim MK, Lee TK, Lee KS, Jeun SS, Park CK, et al. Temozolomide chemotherapy in patients with recurrent malignant gliomas. J Korean Med Sci. 2006; 21:739–744. PMID: 16891823.

33. Yung WK, Albright RE, Olson J, Fredericks R, Fink K, Prados MD, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer. 2000; 83:588–593. PMID: 10944597.

34. Yung WK, Prados MD, Yaya-Tur R, Rosenfeld SS, Brada M, Friedman HS, et al. Temodal Brain Tumor Group. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. J Clin Oncol. 1999; 17:2762–2771. PMID: 10561351.