HONOLULUSalvage therapy with cisplatin (Platinol), etoposide (VP-16), and
vincristine (CVV) for recurrent malignant gliomas has moderate activity that
may lead to long-term stabilization in heavily pretreated patients, according
to H. Lee Moffitt investigators who presented their findings at the 55th Annual
Meeting of the American Academy of Neurology (abstract P01.001).
A number of patients, particularly those with anaplastic astrocytoma or
anaplastic oligodendroglioma, have achieved sustained remission, and a few are
still alive some 4 years after treatment with this regimen, said Surasak
Phuphanich, MD, professor of neurology and oncology, H. Lee Moffitt Cancer
Center & Research Institute, Tampa, Florida.
From 1998 to 2002, the researchers enrolled 64 patients (median age, 51),
with glioblastoma multiforme (n = 44), anaplastic astrocytoma (n = 12), and
anaplastic oligodendroglioma (n = 8). Patients received cisplatin 100 mg/m2
on day 1, etoposide 100 mg/m2 on days 1 to 3, and vincristine
1.5 mg/m2 on day 1, in a 4-week cycle for a maximum of eight cycles.
Patients were evaluated by neurological exam and MRI every 8 weeks.
Patients had undergone previous surgery, radiation therapy, and up to four
chemotherapy or biotherapy regimens. Twenty-five patients (39%) had undergone
more than two prior chemotherapy regimens. The most common regimens were BCNU (carmustine)/Gliadel
wafer, PCV (procarbazine, CCNU, vincristine), and temozolomide (Temodar).
In some cases, the response was substantial. Dr. Phuphanich described one
patient with a 5-cm lesion recurring after surgery that shrank by 90% after the
CVV regimen ( see Figure ). About 25% of his patients may achieve this degree of
response, he said.
Two anaplastic astrocytoma patients who achieved a durable complete response
did not have previous chemotherapy, indicating that this regimen may be of
value earlier in the treatment algorithm. "For these two patients, the tumor
completely disappeared, and they have been tumor free for about 10 months," he
reported. "That is why we believe this regimen will be most useful upfront,
instead of salvage, in the future."
Time to tumor progression was 19 weeks for glioblastoma multiforme and 60
weeks for anaplastic astrocytoma/anaplastic oligodendroglioma. Two patients are
still in complete remission more than 202 weeks and 242 weeks post-treatment.