Carboplatin and teniposide as third-line chemotherapy in patients with recurrent oligodendroglioma or oligoastrocytoma: a phase II study.

BACKGROUND: This study was a phase II study of third-line chemotherapy with carboplatin plus teniposide in patients with recurrent oligodendroglioma. PATIENTS AND METHODS: Patients with oligodendroglioma progressive or recurrent after surgery, radiotherapy and chemotherapy with PCV (lomustine/procarbazine/vincristine) and temozolomide were treated with 350 mg/m(2) carboplatin on day 1, and 50 mg/m(2) teniposide on days 1-3, every 4 weeks. RESULTS: Response and toxicity were evaluated in all 23 patients enrolled in the study. Two had partial response [8.6%; 95% confidence interval (CI) 1.8% to 28.6%] and 12 stable disease (52.17%; 95% CI 30% to 73%). Median time to progression was 19 weeks (95% CI 11.4-35.0), and 34.8% of the patients (95% CI 20.0% to 61.0%) had progression-free survival at 6 months. Median survival time was 60.7 weeks (95% CI 39.8 to not achieved) and 51% of the patients (95% CI 33.5% to 79.7%) were alive at 12 months. A total of 103 cycles were administered (on average 4.4 per patient; range 1-9). Toxicity was mild and mainly hematological, with grade 4 neutropenia and grade 4 thrombocytopenia in two (8.6%) and three patients (13%), respectively. CONCLUSIONS: Although the response rate of combined carboplatin and teniposide chemotherapy in heavily pretreated oligodendroglial tumors is moderate, the toxicity is manageable, and delay of progression in responders or stable patients may still confer a relevant clinical benefit.

Guidelines for the treatment of malignant gliomas in elderly patients.

More than 80% of intracranial tumours in the elderly are malignant gliomas with aggressive behaviour. Older patients have been frequently excluded from clinical trials in view of their dismal prognosis and low tolerability of chemo-radiotherapy treatments, therefore they were underrepresented in the past oncological literature. Controversies in the use and dose of RT and in the administration of chemotherapeutic agents have not been solved by the small retrospective studies conducted so far. It appears reasonable that an aggressive treatment with surgery, full dose RT and, possibly, chemotherapy should be applied to patients with good performance status, preserved cognitive functions and no relevant comorbidities, although in the absence of randomised studies the balance of benefits and side effects of integrated treatments remains controversial. Patients with low performance status and/or serious comorbidities, unable to undergo surgery, may receive a shorter RT plan, or even no treatment at all, in consideration of the rapid course of their disease which may be shorter than the hypothetical benefit of any specific treatment. Further studies should be designed to perform a reliable analysis of prognostic factors of malignant gliomas in the elderly in order to tailor treatments to each patient to obtain the best feasible benefit without compromising their quality of life.

Temozolomide in patients with high grade gliomas.

The incidence of central nervous system neoplasias ranges from 3.8 to 5.1 cases per 100,000 inhabitants. First-line treatment of brain tumors consists of surgery associated with radiotherapy, and followed or not by chemotherapy. When used as an adjuvant therapy after surgery and radiotherapy, chemotherapy prolongs the time to progression and the median survival time. At relapse, chemotherapy is the common therapeutic approach. In recent years, new drugs for the treatment of brain tumors have been tested, and some of them, such as temozolomide, are very promising.

Reoperation in recurrent high-grade gliomas: literature review of prognostic factors and outcome.

Two percent of cancer deaths are caused by malignant primary brain tumors, and most of these are high-grade gliomas. Despite the treatment given, malignant gliomas recur early. Mean survival is less than 12 months, and only 20% of patients survive for more than 2 years. This rapid course induces some physicians to resort to all the therapeutic options available and, at recurrence, to reevaluate the patient for a second intervention. Others consider reoperation to be an overtreatment. The debate is ongoing, and an answer likely will be found only through better identification of the prognostic factors that will identify patients who will benefit from reoperation.