Andrés J M Ferreri1, Fabio Ciceri, Alba A Brandes, Mauro Montanari, Monica Balzarotti, Michele Spina, Fiorella Ilariucci, Francesco Zaja, Caterina Stelitano, Flavio Bobbio, Gaetano Corazzelli, Luca Baldini, Michele Reni. 1. From the Unit of Lymphoid Malignancies (A.J.M.F.), UTMO & Hematology Unit, Department of Onco-Hematology (F.C.), and Medical Oncology Unit, Department of Oncology (M.R.), San Raffaele Scientific Institute, Milan; Department of Medical Oncology (A.A.B.), Bellaria-Maggiore Hospital, Azienda Unità Sanitaria Locale, Bologna; Division of Hematology (M.M.), Ospedale di Ancona; Department of Medical Oncology and Hematology (M.B.), Istituto Clinico Humanitas, Rozzano; Division of Medical Oncology A (M.S.), National Cancer Institute, Aviano; Division of Hematology (F.I.), Ospedale di Reggio Emilia; Division of Hematology (F.Z.), Ospedale di Udine; Division of Hematology (C.S.), Ospedale di Reggio Calabria; Division of Hematology (F.B.), Ospedale Maggiore di Novara; Division of Hematology (G.C.), Istituto Nazionale dei Tumori Pascale di Napoli; and the Division of Hematology (L.B.), Ospedale Maggiore di Milano, Italy.
Abstract
OBJECTIVE: We report updated results at a median follow-up of 12 years of a phase II trial assessing first-line MATILDE chemotherapy and response-tailored radiotherapy in patients with primary CNS lymphomas (PCNSL). METHODS: Forty-one HIV-negative patients (18-70 years; Eastern Cooperative Oncology Group performance status ≤3) with histologically confirmed PCNSL received 3 courses of MATILDE chemotherapy followed by whole-brain radiotherapy (WBRT). Chemotherapy activity was the primary endpoint. RESULTS: Overall response rate was 76% (95% confidence interval [CI] 63%-89%) after chemotherapy and 83% (95% CI 71%-95%) after chemotherapy ± radiotherapy. At a median follow-up of 144 months (range 47-153), 31 patients experienced an event: relapse in 24, progressive disease in 3, and toxic death in 4, with a 5-year progression-free survival of 24% ± 8%. Two patients experienced a late relapse (100 and 101 months). Nine patients are alive and disease-free, 8 of whom are alive at >10 years, with a 5-year overall survival of 30% ± 7%. At 10 years from diagnosis, no patient showed chronic hematologic and nonhematologic toxicities, with a Mini-Mental State Examination score of ≥29 in all cases but one. CONCLUSIONS: At a median follow-up of 12 years, MATILDE regimen followed by WBRT confirmed the previously reported survival plateau, which further proves its long-lasting efficacy with acceptable neurologic deficits. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients with PCNSL, MATILDE chemotherapy followed by response-tailored radiotherapy increases the probability of disease remission at 12 years.
OBJECTIVE: We report updated results at a median follow-up of 12 years of a phase II trial assessing first-line MATILDE chemotherapy and response-tailored radiotherapy in patients with primary CNS lymphomas (PCNSL). METHODS: Forty-one HIV-negative patients (18-70 years; Eastern Cooperative Oncology Group performance status ≤3) with histologically confirmed PCNSL received 3 courses of MATILDE chemotherapy followed by whole-brain radiotherapy (WBRT). Chemotherapy activity was the primary endpoint. RESULTS: Overall response rate was 76% (95% confidence interval [CI] 63%-89%) after chemotherapy and 83% (95% CI 71%-95%) after chemotherapy ± radiotherapy. At a median follow-up of 144 months (range 47-153), 31 patients experienced an event: relapse in 24, progressive disease in 3, and toxic death in 4, with a 5-year progression-free survival of 24% ± 8%. Two patients experienced a late relapse (100 and 101 months). Nine patients are alive and disease-free, 8 of whom are alive at >10 years, with a 5-year overall survival of 30% ± 7%. At 10 years from diagnosis, no patient showed chronic hematologic and nonhematologic toxicities, with a Mini-Mental State Examination score of ≥29 in all cases but one. CONCLUSIONS: At a median follow-up of 12 years, MATILDE regimen followed by WBRT confirmed the previously reported survival plateau, which further proves its long-lasting efficacy with acceptable neurologic deficits. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients with PCNSL, MATILDE chemotherapy followed by response-tailored radiotherapy increases the probability of disease remission at 12 years.
Authors: Alexis A Morell; Ashish H Shah; Claudio Cavallo; Daniel G Eichberg; Christopher A Sarkiss; Ronald Benveniste; Michael E Ivan; Ricardo J Komotar Journal: Neurooncol Pract Date: 2019-04-27
Authors: Ni Fan; Lu Zhang; Xiaoping Xu; Bobin Chen; Chen Zhu; Pei Li; Zi Chen; Tianling Ding; Yan Ma; Yan Yuan; Zhiguang Lin Journal: Oncotarget Date: 2017-03-04