QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Home | Help | Feedback | Subscriptions | Archive | Search | Table of Contents

This Article Full Text Full Text (PDF) All Versions of this Article: 9/3/354    most recent 15228517-2007-006v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Kesari, S. Articles by Wen, P. Y. Search for Related Content PubMed PubMed Citation Social Bookmarking                   What's this?

Phase II study of metronomic chemotherapy for recurrent malignant gliomas in adults

Dana-Farber/Brigham and Women's Cancer Center (S.K., L.D., D.C.G., J.D., N.R., S.E.W., B.L., J.B., P.M.B., P.Y.W.), Boston, MA 02115; Departments of Neurology (S.K., J.D., A.S.C.-P., P.Y.W.), Neurosurgery (P.M.B.), and Radiation Oncology (N.R., S.E.W.), Brigham and Women's Hospital, Boston, MA 02115; Neuro-Oncology Center (D.S.), University of Virginia, Charlottesville, VA; Department of Neurology (T.T.B., A.O., J.K.), Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA 02114; Department of Biostatistics, Massachusetts General Hospital (A.M.), Boston, MA 02114; Department of Surgery (A.L., J.F., M.K.), Vascular Biology Program, Children's Hospital, Boston, MA 02115; and Division of Pediatric Oncology (A.L., M.K.), Dana-Farber Cancer Institute and Children's Hospital, Boston, MA 02115; Harvard Medical School (S.K., T.T.B., A.M., A.O., J.D., A.S.C.-P., N.R., S.E.W., P.M.B., J.F., M.K., P.Y.W.), Boston, MA 02115; USA

Address correspondence to Patrick Y. Wen, Center for Neuro-Oncology, Dana-Farber Cancer Institute, 44 Binney Street, SW430D, Boston, MA 02115, USA.

Preclinical evidence suggests that continuous low-dose daily (metronomic) chemotherapy may inhibit tumor endothelial cell proliferation (angiogenesis) and prevent tumor growth. This phase II study evaluated the feasibility of this antiangiogenic chemotherapy regimen in adults with recurrent malignant gliomas. The regimen consisted of low-dose etoposide (35 mg/m² [maximum, 100 mg/day] daily for 21 days), alternating every 21 days with cyclophosphamide (2 mg/kg [maximum, 100 mg/day] daily for 21 days), in combination with daily thalidomide and celecoxib, in adult patients with recurrent malignant gliomas. Serum and urine samples were collected for measurement of angiogenic peptides. Forty-eight patients were enrolled (15 female, 33 male). Twenty-eight patients had glioblastoma multiforme (GBMs), and 20 had anaplastic gliomas (AGs). Median age was 53 years (range, 33-74 years), and median KPS was 70 (range, 60-100). Therapy was reasonably well tolerated in this heavily pretreated population. Two percent of patients had partial response, 9% had a minor response, 59% had stable disease, and 30% had progressive disease. For GBM patients, median progression-free survival (PFS) was 11 weeks, six-month PFS (6M-PFS) was 9%, and median overall survival (OS) was 21 weeks. For AG patients, median PFS was 14 weeks, 6M-PFS was 26%, and median OS was 41.5 weeks. In a limited subset of patients, serum and urine angiogenic peptides did not correlate with response or survival (p > 0.05). Although there were some responders, this four-drug, oral metronomic regimen did not significantly improve OS in this heavily pretreated group of patients who were generally not eligible for conventional protocols. While metronomic chemotherapy may not be useful in patients with advanced disease, further studies using metronomic chemotherapy combined with more potent antiangiogenic agents in patients with less advanced disease may be warranted.

Key Words: angiogenesis • antiangiogenesis • clinical trial • glioblastoma • metronomic chemotherapy

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				A. S. Chi, A. G. Sorensen, R. K. Jain, and T. T. Batchelor Angiogenesis as a Therapeutic Target in Malignant Gliomas Oncologist, June 1, 2009; 14(6): 621 - 636. [Abstract] [Full Text] [PDF]

				S. Kesari, D. Schiff, J. Drappatz, D. LaFrankie, L. Doherty, E. A. Macklin, A. Muzikansky, S. Santagata, K. L. Ligon, A. D. Norden, et al. Phase II Study of Protracted Daily Temozolomide for Low-Grade Gliomas in Adults Clin. Cancer Res., January 1, 2009; 15(1): 330 - 337. [Abstract] [Full Text] [PDF]

				P. Y. Wen, A. D. Norden, and J. Drappatz Antiangiogenic Therapies for Malignant Gliomas ASCO Educational Book, January 1, 2009; 2009(1): 113 - 117. [Abstract] [Full Text] [PDF]

				A. Idbaih, F. Ducray, M. Sierra Del Rio, K. Hoang-Xuan, and J.-Y. Delattre Therapeutic Application of Noncytotoxic Molecular Targeted Therapy in Gliomas: Growth Factor Receptors and Angiogenesis Inhibitors Oncologist, September 1, 2008; 13(9): 978 - 992. [Abstract] [Full Text] [PDF]

				S. Kesari, D. Schiff, J. W. Henson, A. Muzikansky, D. C. Gigas, L. Doherty, T. T. Batchelor, J. A. Longtine, K. L. Ligon, S. Weaver, et al. Phase II study of temozolomide, thalidomide, and celecoxib for newly diagnosed glioblastoma in adults Neuro-oncol, January 1, 2008; 10(3): 300 - 308. [Abstract] [Full Text] [PDF]