Anne[a]
ASCO 2005 Abstract No: 1580
TMZ and PCV in unresectable high grade gliomas: a retrospective comparison between two common schedules
M. Quirino, M. Basso, N. Trigila, E. D´Argento, G. Schinzari, A. Iaculli, C. Pozzo, A. Cassano, M. Landriscina, C. Barone
Backgrond:
Treatment of unresectable high grade gliomas still remains a controversal item. After surgery and radiotherapy, chemotherapy is the only chance for these patients (pts) even though benefits are unclear in spite of significant side effects. In this retrospective study we compared in terms of response rate, toxicity, time to progression and survival two regimens commonly used in this setting.
Methods:
We evaluated 52 pts, 31 male and 18 female; median age was 46 years (range 21-71). Sixteen of them had histologic diagnosis of anaplastic astrocytoma (AA), 14 of glioblastoma multiforme (GM) and 19 of oligodendroglioma (ODG). PS ECOG was 0 to 3. Thirtyone pts received temozolomide (TMZ) p.o. 200 mg/m2, days 1 to 5 every 28; 18 received chemotherapy according to PCV schedule (Lomustine 110 mg/m2 p.o. day 1, Procarbazine 60 mg/m2 p.o. days 2 to 8, Vincristine 1,4 mg/m2 i.v. days 8 and 29). Treatment was interrupted in case of disease progression or unacceptable toxicity.
Results:
We observed no complete responses; partial responses were 7 (22,6%) and 3 (16,7%), stable disease 13 (42%) and 10 (55,5%), progressions 11 (35,6%) and 5 (27,8%) in the TMZ and PCV groups, respectively. Hematological toxicity was generally mild in the TMZ group in comparison with the PCV population (grade III-IV NCI-CTC neutropenia and thrombocitopenia were observed in 3,8% and 12,1% of cycles, respectively). Median overall survival and time to progression were 10 and 8 months in the TMZ group and 18 and 9,5 in the PCV group, respectively.
Conclusions;
PCV seems to be more effective and more toxic than TMZ. However, the histological stratification revealed a prevalence of ODG (better prognosis than other malignant glial tumors) in the PCV group. Re-evaluating our results on this basis, differences between the two groups in terms of efficacy disappeared. TMZ still showed a better profile in terms of safety.