Cisplatin and Temozolomide Combination in the Treatment of Supratentorial Anaplastic Ependymoma

Lombardi, Giuseppe; Pambuku, Ardi; Bellu, Luisa; Puppa, Alessandro Della; Rumano, Laura; Gardiman, Marina Paola; Pomerri, Fabio; Zagonel, Vittorina

doi:10.1159/000355662

Cited by 14 publications

(9 citation statements)

References 21 publications

(24 reference statements)

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“…Platinum-based antineoplastic agents alone or in combination with other drugs have been used for the treatment of gliomas for at least 2 decades [16,17]. A rather intense regimen, including ifosfamide, carboplatin, and etoposide (ICE), was administered to patients with high-grade glioma at a second or third tumor recurrence [18].…”

Section: Discussionmentioning

confidence: 99%

Carboplatin and Etoposide in Heavily Pretreated Patients with Progressive High-Grade Glioma

et al. 2014

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Background: Treatment of recurrent anaplastic glioma and glioblastoma remains a particular challenge in neurooncology. The lack of controlled trials results in poor evidence for all therapeutic options. Upon recurrence, many patients are treated with bevacizumab or one of the frequently used nitrosoureas such as lomustine. However, patients who still present in overall good condition after failure of multiple lines of therapy may ask for additional therapy. Methods: Here, we report our experience with the use of carboplatin in combination with etoposide as fourth- or fifth-line therapy in patients with progressive high-grade glioma. Results: The median Karnofsky performance status at the beginning of treatment was 80%. The median progression-free survival (PFS) was 2.5 months. PFS at 6 months was 0%. Administration of carboplatin and etoposide was associated with grade 3 or 4 hematotoxicity in 8 of 12 patients. Conclusion: Carboplatin in combination with etoposide has an unfavorable risk-benefit profile in heavily pretreated glioma patients.

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Section: Discussionmentioning

confidence: 99%

Carboplatin and Etoposide in Heavily Pretreated Patients with Progressive High-Grade Glioma

et al. 2014

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“…Ultimately, clinical data were obtained from 27 of 53 articles, and 101 patients from the literature were identified. 3,[4][5][6][7]11,[13][14][15]17,18,[24][25][26][27][28][29]34,35,[40][41][42]44,49,52,53,58 Article authors were not contacted for additional data. A total of 109 patients from both study populations were included in our investigation, and 77 patients had complete clinical information as described below.…”

Section: Methods Patient Population and Article Selectionmentioning

confidence: 99%

Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors

Hollon¹,

Nguyen

Smith³

et al. 2016

JNS

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IntracranIal ependymomas are the third most common glioma in adults, behind astrocytomas and oligodendrogliomas. Ependymomas constitute 3% of primary CNS tumors and 6.7% of gliomas diagnosed each year in the US. 31,32 Safe maximal resection remains the mainstay of treatment. Radiation and chemotherapy may be provided as adjuvant treatments, especially in the setting of subtotal resection (STR). Reported 5-year overall survival (OS) rates for adults with intracranial ependymoma range widely from 35% to 90%. 9,19,21,47,54 Controversy exists regarding important prognostic factors for progression-free survival (PFS) and OS. 1,37,57 Reported prognostic factors include age, Karnofsky performance status, tumor location, tumor grade, extent of resection (EOR), and postoperative radiation. 8,9,[19][20][21][22][46][47][48]54 Evidence supports the idea that supratentorial ependymomas have a worse prognosis than infratentorial tumors do in adults. 9,19,20,23,38,45,46 Additional data indicate that patients with hemispheric ependymomas have decreased PFS and OS compared with tumors occurring in the third or lateral ventricles. 9,45 Although often considered an intraventricular tumor, more than half of supratentorial epabbreviatioNs EOR = extent of resection; GTR = gross total resection; OS = overall survival; PFS = progression-free survival; STR = subtotal resection. obJective Survival rates and prognostic factors for supratentorial hemispheric ependymomas have not been determined. The authors therefore designed a retrospective study to determine progression-free survival (PFS), overall survival (OS), and prognostic factors for hemispheric ependymomas. methods The study population consisted of 8 patients from our institution and 101 patients from the literature with disaggregated survival information (n = 109). Patient age, sex, tumor side, tumor location, extent of resection (EOR), tumor grade, postoperative chemotherapy, radiation, time to recurrence, and survival were recorded. Kaplan-Meier survival analyses and Cox proportional hazard models were completed to determine survival rates and prognostic factors. results Anaplastic histology/WHO Grade III tumors were identified in 62% of cases and correlated with older age. Three-, 5-, and 10-year PFS rates were 57%, 51%, and 42%, respectively. Three-, 5-, and 10-year OS rates were 77%, 71%, and 58%, respectively. EOR and tumor grade were identified on both Kaplan-Meier log-rank testing and univariate Cox proportional hazard models as prognostic for PFS and OS. Both EOR and tumor grade remained prognostic on multivariate analysis. Subtotal resection (STR) predicted a worse PFS (hazard ratio [HR] 4.764, p = 0.001) and OS (HR 4.216, p = 0.008). Subgroup survival analysis of patients with STR demonstrated a 5- and 10-year OS of 28% and 0%, respectively. WHO Grade III tumors also had worse PFS (HR 10.2, p = 0.004) and OS (HR 9.1, p = 0.035). Patients with WHO Grade III tumors demonstrated 5- and 10-year OS of 61% and 46%, respectively. Postoperative radiation was not prognostic f...

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“…A variety of chemotherapeutic drugs has been investigated in the past, mostly in retrospective studies or case reports. Selected case reports demonstrate response to temozolomide (TMZ) in recurrent WHO grade III ependymoma [ 12 , 13 ] or recurrent WHO grade II and III ependymomas [ 14 ]. Activity of TMZ was also described in a retrospective study, analyzing recurrent WHO grade II ependymomas, refractory for platinum-based chemotherapy [ 15 ], as well as in a prospective phase II study in ependymoma patients treated with TMZ and lapatinib at tumor recurrence [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy for intracranial ependymoma in adults

et al. 2016

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BackgroundEpendymal tumors in adults are rare, accounting for less than 4 % of primary tumors of the central nervous system in this age group. The low prevalence of intracranial ependymoma in adults limits the ability to perform clinical trials. Therefore, treatment decisions are based on small, mostly retrospective studies and the role of chemotherapy has remained unclear.MethodsWe performed a retrospective study on 17 adult patients diagnosed with intracranial World Health Organisation grade II or III ependymoma, who were treated with chemotherapy at any time during the disease course. Benefit from chemotherapy was estimated by applying Macdonald criteria. Progression-free (PFS) and overall survival (OS) were calculated from start of chemotherapy, using the Kaplan-Meier method.ResultsEleven patients had supratentorial and 6 infratentorial tumors. Ten patients were treated with temozolomide (TMZ), 3 with procarbazine/lomustine/vincristine (PCV), 3 with platinum-based chemotherapy and 1 patient received epirubicin/ifosfamide. Response rates were as follows: TMZ 8/10 stable disease; PCV 3/3 stable disease; platinum-based chemotherapy 1/3 partial response; epirubicin/ifosfamide 1/1 complete response. PFS rates at 6, 12 and 24 months were 52.9, 35.3 and 23.5 %. OS rates at 6, 12 and 24 months were 82.4, 82.4 and 70.1 %. There was no indication for a favourable prognostic role of O6-methylguanyl-DNA-methyltransferase (MGMT) promoter methylation which was detected in 3/12 investigated tumors.ConclusionsSurvival outcomes in response to chemotherapy in adult intracranial ependymoma patients vary substantially, but individual patients may respond to any kind of chemotherapy. There were too few patients to compare survival data between chemotherapeutic subgroups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2323-0) contains supplementary material, which is available to authorized users.

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Cisplatin and Temozolomide Combination in the Treatment of Supratentorial Anaplastic Ependymoma

Cited by 14 publications

References 21 publications

Carboplatin and Etoposide in Heavily Pretreated Patients with Progressive High-Grade Glioma

Carboplatin and Etoposide in Heavily Pretreated Patients with Progressive High-Grade Glioma

Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors

Chemotherapy for intracranial ependymoma in adults

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