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Phase 2 trial of BCNU plus irinotecan in adults with malignant glioma

Departments of Surgery (D.A.R., J.A.Q., J.N.R., S.G., J.V., J.H.S., A.W., M.B., S.T.-U., M.L.A., S.J., D.A., K.Z., S.S., C.B., A.H.F., D.D.B., H.S.F.), Neurology (J.A.Q., J.N.R.), Pediatrics (D.A.R., S.G., H.S.F.), Radiology (J.M.P.), Cancer Center Biostatistics (J.E.H., J.M.D.), and Pathology (D.D.B.), Duke University Medical Center, Durham, NC 27710, USA

² Address correspondence to David A. Reardon, The Brain Tumor Center at Duke, Duke University Medical Center, Box 3624, Durham, NC 27710 (reard003{at}mc.duke.edu).

Abstract

In preclinical studies, BCNU, or 1,3-bis(2-chloroethyl)-1-nitrosourea, plus CPT-11 (irinotecan) exhibits schedule-dependent, synergistic activity against malignant glioma (MG). We previously established the maximum tolerated dose of CPT-11 when administered for 4 consecutive weeks in combination with BCNU administered on the first day of each 6-week cycle. We now report a phase 2 trial of BCNU plus CPT-11 for patients with MG. In the current study, BCNU (100 mg/m²) was administered on day 1 of each 6-week cycle. CPT-11 was administered on days 1, 8, 15, and 22 at 225 mg/m² for patients receiving CYP3A1- or CYP3A4-inducing anticonvulsants and at 125 mg/m² for those not on these medications. Newly diagnosed patients received up to 3 cycles before radiotherapy, while recurrent patients received up to 8 cycles. The primary end point of this study was radiographic response, while time to progression and overall survival were also assessed. Seventy-six patients were treated, including 37 with newly diagnosed tumors and 39 with recurrent disease. Fifty-six had glioblastoma multiforme, 18 had anaplastic astrocytoma, and 2 had anaplastic oligodendroglioma. Toxicities (grade 3) included infections (13%), thromboses (12%), diarrhea (10%), and neutropenia (7%). Interstitial pneumonitis developed in 4 patients. Five newly diagnosed patients (14%; 95% CI, 5%-29%) achieved a radiographic response (1 complete response and 4 partial responses). Five patients with recurrent MG also achieved a response (1 complete response and 4 partial responses; 13%; 95% CI, 4%-27%). More than 40% of both newly diagnosed and recurrent patients achieved stable disease. Median time to progression was 11.3 weeks for recurrent glioblastoma multiforme patients and 16.9 weeks for recurrent anaplastic astrocytoma/anaplastic oligodendroglioma patients. We conclude that the activity of BCNU plus CPT-11 for patients with MG appears comparable to that of CPT-11 alone and may be more toxic.

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