Effect of temozolomide chronotherapy in patients with high-grade glioma.

Abstract

e14525 Background: High grade gliomas (HGG) (the most common being glioblastoma) are the most common primary CNS malignancy in adults. Mainstay of therapy is surgical resection followed by concurrent radiation and temozolomide (TMZ) followed by adjuvant TMZ. Unfortunately, prognosis remains poor and optimization of current therapy is critical. Chronotherapy is defined as improvement in treatment outcomes by maximizing treatment efficacy and minimizing toxicity by administering medications in accordance with biological rhythms of the patient. In a mouse model, there was greater anti-tumor efficacy during morning administration of TMZ. This trial was designed to determine the feasibility and potential clinical impact of chrono-therapeutically administering TMZ in patients with HGG. Methods: Adult patients ( > 18 years) with HGG (WHO Grade III/IV) were eligible. Patients were screened and consented prior to initiation of monthly TMZ therapy. Eligible patients were randomized to TMZ in the morning (AM) before 10AM or in the evening (PM) after 8PM. Pill diaries were recorded for drug administration time and compliance. Fact-Br Quality of Life (QoL) surveys were administered to patients at the time of enrollment in the trial and at the end of treatment to measure differences in QoL in both groups. Circadian rhythm was recorded by Actiwatch. Adverse events (AE), overall survival (OS) and progression free survival (PFS) were measured for each group. Results: At the time of submission, a total of 28 patients were evaluated. 15 patients were in AM group and 13 in PM group. It is feasible for participants to take TMZ per study assignment. There was no significant difference in the QoL based on the Fact-Br dataset in the four main categories of physical well-being, social/family well-being, functional well-being and emotional well-being. The Friedman’s two-way nonparametric ANOVA tests were used to analyze the differences across time points. Cytopenias are a known adverse effect of TMZ. There was a trend towards worsening lymphocyte counts in the AM group compared to PM group, although not statistically significant. There was no statistical significance in PFS or OS in patients with newly diagnosed glioblastoma. Conclusions: Chronotherapy with TMZ is feasible. A trend of worsening lymphocyte counts is noted in AM treatment group compared to PM group but was not statistically significant. No difference in OS or PFS was noted, although sample size was too small to effectively assess this. A larger study will need to be conducted to effectively assess the effect of chronotherapy on survival. Clinical trial information: NCT02781792.

Temozolomide Chronotherapy in Glioma: A Systematic Review

“…The updated manual search yielded one other publication. After reviewing all the candidate full-text manuscripts, four citations were eligible per the inclusion and exclusion criteria [19][20][21][22], listed in Table 1; and underwent complete abstraction. The details of article exclusion during second-stage screening are recorded in Supplement Table S2.…”

“…Throughout abstraction, it became apparent that two of the eligible conference abstracts [21,22] and one full-text manuscript reported on the same prospective study by Damato et al (2022), as they referenced the same National Clinical Trial (NCT) number [20]. Therefore, only the recently published, comprehensive article was included for synthesis.…”

“…All four eligible abstracts [19][20][21][22] were published by the neuro-oncology group at Washington University School of Medicine, United States (Table 1). However, only two articles were included for synthesis, as three publications originated from the same study at various stages of completion.…”

“…However, only two articles were included for synthesis, as three publications originated from the same study at various stages of completion. Two were published as conference abstracts [21,22], and one was a recently published manuscript [20]. Only this full manuscript, which reported a single-center prospective, randomized study (n = 35) comparing feasibility and adverse effects in two cohorts defined by the timing of TMZ administration, was included in the review synthesis.…”

“…MGMT methylation status, the extent of surgical resection, and prior chemotherapy and radiation treatment were comparable between groups. The prospective randomized feasibility study that released preliminary results by Campian et al [21]; then, Atluri et al [22]; and finally, published as a peer-reviewed manuscript by Damato et al [20] reported no significant difference in OS or PFS between the morning and evening administration groups. However, the sample size was too small (n = 35) for survival comparisons.…”