Gleevec als Monotherapie in der Behandlung von Glioblastomen hat in der Studie (siehe unten) nicht viel gebracht. In Deutschland wird an verschiedenen Kliniken (z.B. Mannheim, Dülmen) Gleevec in Kombination mit anderen Medikamenten eingesetzt. Ob davon ein besseres Ergebnis zu erwarten ist, werden die Studien zeigen.
38th ASCO Annual Meeting . Orlando, FL . May 18-21, 2002
(Abstract No. 288)
Phase I study of STI571 (Gleevec) for patients with recurrent malignant gliomas and meningiomas (NABTC 99-08)
Patrick Y Wen, W K Yung, Kenneth Hess, Sandra Silberman, Michael Hayes, David Schiff, Frank Lieberman, Timothy F Cloughesy, Lisa M DeAngelis, Susan M Chang, Larry Junck, Howard A Fine, Karen Fink, H I Robins, Jeffrey J Raizer, Lauren E Abrey, Minesh P Mehta, Elizabeth A Maher, Peter M Black, John Kuhn, Renaud Capdeville, Richard S Kaplan, Anthony Murgo, Charles Stiles, Michael D Prados
Dana-Farber Cancer Inst, Boston, MA; M.D. Anderson Cancer Center, Houston, TX; Novartis Oncology, E. Hanover, NJ; University of Pittsburgh Medical Center, Pittsburgh, PA; Uinversity of California Los Angeles, Los Angeles, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Univ of California San Francisco, San Francisco, CA; University of Michigan, Ann Arbor, MI; National Institutes of Health, Washington, DC; University of Texas, Southwestern Medical Center, Dallas, TX; University of Wisconsin, Madison, WI; Brigham and Women´s Hospital, Boston, MA; University of Texas, San Antonio, TX; Novartis Oncology, Basle, Switzerland; National Cancer Institute, Washington, DC
STI571 (Gleevec) is a small molecule tyrosine kinase inhibitor of the BCR-ABL and c-kit tyrosine kinases, as well as the receptors for platelet-derived growth factor (PDGF). PDGF and its receptors are frequently expressed together in gliomas raising the possibility that an autocrine/paracrine loop may contribute to the pathogenesis of these tumors. PDGF may also play an important role in the angiogenesis associated with malignant gliomas.
In preclinical studies, STI571 inhibited the growth of U343 and U87 glioblastoma cell lines in vitro and in orthotopic murine models with subcutaneous and intracranial tumors (Cancer Res 2000;60:5143-5150).
These studies suggest that STI571 may have therapeutic potential in patients with malignant gliomas. The North American Brain Tumor Consortium (NABTC) began a phase I/II study of STI571 in patients with recurrent malignant gliomas and meningiomas in March, 2001 (NABTC 99-08). Patients were assigned to one of two groups depending on whether they are taking enzyme inducing anti-epileptic drugs or not. To date, 40 patients have been enrolled. Cohorts of patients were treated with 400, 600, 800, and most recently 1000 mg/day of STI571. Histologies include 24 GBM, 8 anaplastic oligodendroglioma, 6 anaplastic astrocytoma, 1 anaplastic mixed glioma and 1 meningioma. MTD has not yet been determined. Two patients experienced grade 5 toxicity (1 intracerebral hemorrhage in the setting of tumor progression and thrombocytopenia; 1 pneumocystis pneumonia in a patient on corticosteroids), 4 patients had grade 4 toxicity and 10 had grade 3 toxicity. Of the 31 patients to date who were evaluable for response, 14 patients had stable disease, 4 longer than 24 weeks. The final results of the phase I study and pharamcokinetic data will be presented.
© Copyright 2002 American Society of Clinical Oncology
Nebenwirkungen von Glivec:
Majority of patients treated with GleevecT exhibit therapy-related adverse effects. The most common side effects associated with GleevecT therapy were nausea, fluid retention, vomiting, diarrhea, hemorrhage, muscle cramps, skin rash, fatigue, headache, dyspepsia, dyspnea, neutropenia, and thrombocytopenia. Serious and severe side effects, including hepatotoxicity (in 1% to 4% of patients), fluid retention syndrome (in 3% to 12% of patients), neutropenia (in 8% to 48% of patients), and thrombocytopenia (in less than 1% to 33% of patients) were also reported.
Gleevec was originally designed to inhibit a receptor kinase called PDGFR-beta, which is hyperactive in glioma, a brain cancer. But it also turned out to inhibit another kinase receptor called c-kit, which is overexpressed in gastrointestinal stromal cancer, as well as abl, the internal kinase whose gene goes awry in chronic myelogenous leukemia.
