Effectiveness of Interferon-β, ACNU, and Radiation Therapy in Pediatric Patients with Brainstem Glioma

Abstract

Sixteen pediatric patients with brainstem glioma were treated with a combination of interferon-beta, 1-(4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitroso ure a hydrochloride (ACNU), and radiation therapy (IAR therapy). All patients received 1-1.5 million IU/day of interferon-beta intravenously for 1 week of each 6-week cycle. In addition, ACNU (2-3 mg/kg) was given on the 2nd day of each cycle. Conventional focal irradiation (1.5-2 Gy/day for 5 days to a total dosage of 40-60 Gy) was administered beginning on day 3. Patients underwent at least two 6-week cycles. Adverse effects included nausea, vomiting, and myelosuppression, but were mild and transient. Response to treatment was evaluated by the reduction in tumor size measured on postcontrast computed tomographic scans and magnetic resonance images. Responses occurred in 10 of 11 patients with the intrinsic type of brainstem glioma, including three complete and seven partial responses. Two of five patients with exophytic type gliomas partially responded. The median survival was 15.7 months, a remarkable improvement over the natural course of this disease. These results indicate that IAR therapy is a useful primary treatment for pediatric patients with brainstem gliomas.

Alternative Therapies for Children with Brain Stem Gliomas: Immunotherapy and Gene Therapy

“…A more promising result was reported by Wakabayashi et al [19] in 16 pediatric patients with brain stem gliomas treated with P-interferon, ACNU and radiation therapy. Conventional radiation therapy was given to a total dose that ranged between 4,000 and 6.000 cGy.…”

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

“…58,112,120 In 1 study, investigators explored the role of the administration of high-dose busulfan and thiotepa after conventional radiotherapy in 35 patients with diffuse pontine gliomas. 15 The median survival time was 10 months, which was no better in comparison with radiotherapy alone.…”

Current Management of Brainstem Gliomas.

“…One of the most popular topics in this field is the interferon, which unfortunately yielded limited and problematic results. Wakabayashi et al (50) who added interferon-α to chemotherapy and RT reported 3 complete and 9 partial responses in a cohort of 16 diffuse BSG patients, and the responders had a median survival times better than the frequently reported <10 months period. In contrast, Packer et al (51) was not able to confirm this promising outcome in a further phase I/II study in 32 BSG patients, rendering the role of immunotherapy questionable.…”