Veronica Villani1, Elena Anghileri2, Luca Prosperini3, Giuseppe Lombardi4, Roberta Rudà5, Paola Gaviani6, Simona Rizzato7, Gaetano Lanzetta8,9, Alessandra Fabi10, Claudia Scaringi11, Edoardo Pronello5, Giorgia Simonetti6, Giada Targato7, Andrea Pace12. 1. Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. veronica.villani@ifo.gov.it. 2. Molecular Neuroncology Unit Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy. 3. Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy. 4. Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy. 5. Department of Neuro-Oncology, City of Health and Science Hospital, Turin, Italy. 6. Neuro-Oncology Unit Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy. 7. Department of Oncology, Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. 8. Oncology Department, Istituto Neurotraumatologico Italiano, Grottaferrata, RM, Italy. 9. Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Neuromed, Pozzilli, Italy. 10. Phase 1 Unit and Precision Medicine-IRCSS Regina Elena National Cancer Institute, Rome, Italy. 11. Radiation Oncology Unit, UPMC Hillman Cancer Center, San Pietro Hospital FBF, Rome, Italy. 12. Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
Abstract
BACKGROUND: Malignant gliomas (MG) are aggressive brain tumours in adults. The standard of care is concurrent radiation plus temozolomide (TMZ) [chemo-radiotherapy (CRT)] followed by TMZ maintenance up to 6 months. TMZ is considered to have a low toxicity profile, but several studies reported occurrence of severe myelosuppression, especially during the concomitant phase. Toxicity may be prolonged, thus treatment should be discontinued. PURPOSE: To evaluate the risk of recurrente myelotoxicity during adjuvant chemotherapy (CT) in patients who recovered from severe myelotoxicity during CRT. METHODS: We retrospectively collected data on patients with MG who developed and recovered from severe myelotoxicity during CRT from eight Italian neuro-oncology centers. RESULTS: We included 87 patients. Histology was Glioblastoma (GBM) in 78 patients (89.7%); 60% of patients were female. After myelotoxicity recovery, 54 (62%) received treatment. The majority of them (82%, n = 44) received adjuvant TMZ and 18% (n = 10) others treatments. Out of 44 patients who received adjuvant TMZ, 34% experienced the re-occurrence of grade 3-4 myelotoxicity which required permanent CT discontinuation in 6 (13%) cases. Patients who received TMZ or other treatments had longer overall (OS) (adjusted HR 0.46, p = 0.008) and progression free survival (PFS) (adjusted HR 0.57, p = 0.034) than those who remained untreated. CONCLUSION: Our study suggests that after severe myelotoxicity the majority of patients received treatment, particularly with TMZ. Only a fraction of patients experienced toxicity recurrence, suggesting that TMZ is well tolerated and had an impact on PFS and OS.
BACKGROUND:Malignant gliomas (MG) are aggressive brain tumours in adults. The standard of care is concurrent radiation plus temozolomide (TMZ) [chemo-radiotherapy (CRT)] followed by TMZ maintenance up to 6 months. TMZ is considered to have a low toxicity profile, but several studies reported occurrence of severe myelosuppression, especially during the concomitant phase. Toxicity may be prolonged, thus treatment should be discontinued. PURPOSE: To evaluate the risk of recurrente myelotoxicity during adjuvant chemotherapy (CT) in patients who recovered from severe myelotoxicity during CRT. METHODS: We retrospectively collected data on patients with MG who developed and recovered from severe myelotoxicity during CRT from eight Italian neuro-oncology centers. RESULTS: We included 87 patients. Histology was Glioblastoma (GBM) in 78 patients (89.7%); 60% of patients were female. After myelotoxicity recovery, 54 (62%) received treatment. The majority of them (82%, n = 44) received adjuvant TMZ and 18% (n = 10) others treatments. Out of 44 patients who received adjuvant TMZ, 34% experienced the re-occurrence of grade 3-4 myelotoxicity which required permanent CT discontinuation in 6 (13%) cases. Patients who received TMZ or other treatments had longer overall (OS) (adjusted HR 0.46, p = 0.008) and progression free survival (PFS) (adjusted HR 0.57, p = 0.034) than those who remained untreated. CONCLUSION: Our study suggests that after severe myelotoxicity the majority of patients received treatment, particularly with TMZ. Only a fraction of patients experienced toxicity recurrence, suggesting that TMZ is well tolerated and had an impact on PFS and OS.
Authors: Ami Sabharwal; Rachel Waters; Sarah Danson; Andrew Clamp; Paul Lorigan; Nick Thatcher; Geoffrey P Margison; Mark R Middleton Journal: Melanoma Res Date: 2011-12 Impact factor: 3.599
Authors: Surein Arulananda; James Lynam; Mun Sem Liew; Morikatsu Wada; Lawrence Cher; Hui K Gan Journal: Intern Med J Date: 2018-10 Impact factor: 2.048
Authors: David E Gerber; Stuart A Grossman; Michel Zeltzman; Michele A Parisi; Lawrence Kleinberg Journal: Neuro Oncol Date: 2006-11-15 Impact factor: 12.300
Authors: H Ian Robins; Jens Eickhoff; Mark R Gilbert; Terri S Armstrong; Wenyin Shi; John F De Groot; Christopher J Schultz; Grant K Hunter; Egils Valeinis; Mack Roach; Emad F Youssef; Luis Souhami; Steve P Howard; Frank S Lieberman; James G Herman; Peixin Zhang; Minesh P Mehta Journal: Neurooncol Pract Date: 2019-04-06