Temozolomide in the treatment of high-grade gliomas in children: a report from the Children's Oncology Group

Cohen, Kenneth J.; Pollack, Ian F.; Zhou, Tianni; Buxton, Allen; Holmes, Emi; Burger, Peter C.; Brat, Daniel J.; Rosenblum, Marc K.; Hamilton, Ronald L.; Lavey, Robert S.; Heideman, Richard L.

doi:10.1093/neuonc/noq191

Cited by 332 publications

(325 citation statements)

References 23 publications

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“…Treatment was commenced according to the ACNS0126 protocol with temozolomide (90 mg/m 2 ) for 42 days with concomitant radiotherapy (45 Gy) to the tumour bed 3 . Because of grade 4 myelosuppression lasting 5 weeks and the reappearance of clinical symptoms, that treatment protocol was stopped.…”

Section: Case Descriptionmentioning

confidence: 99%

Successful Use of Metronomic Vinblastine and Fluorothymidine pet Imaging for the Management of Intramedullary Spinal Cord Anaplastic Oligoastrocytoma in a Child

et al. 2014

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Exploration of new therapeutic options and management strategies is an ongoing need. CASE DESCRIPTIONAn 11-year-old girl had a history of progressive low back pain, incontinence, and paraparesis of both lower extremities lasting 4 months before her diagnosis with an intramedullary spinal cord tumour at the T9-10 level. Sensory irritative paresthesia with prurigo and perception changes led to intensive scratching and a bacterial superinfection resembling scabies. Histopathology revealed an anaplastic oligoastrocytoma, World Health Organization grade 3 as assessed by two board-certified pathologists.Subsequent follow-up with array-based comparative genomic hybridization studies revealed a total loss of 1p and 19q. Magnetic resonance imaging (mri) showed tumour involvement of the whole diameter of spine without any signs of metastatic disease, but complete resection was deemed impossible by several neurosurgeons.Treatment was commenced according to the ACNS0126 protocol with temozolomide (90 mg/m 2 ) for 42 days with concomitant radiotherapy (45 Gy) to the tumour bed 3 . Because of grade 4 myelosuppression lasting 5 weeks and the reappearance of clinical symptoms, that treatment protocol was stopped. The patient was then offered low-dose combat metronomic chemotherapy (temozolomide, etoposide, celecoxib, retinoic acid) 4 , which contained combat ii (plus vitamin D and fenofibrate) and combat iii 5 (plus bevacizumab) for 31 months, using temozolomide 30 mg/m 2 daily for 42 days and etoposide 25 mg/m 2 daily. However, that dosing schedule had to be reduced by 50% because of grades 3 and 4 bone marrow toxicity. Tumour assessment by mri after 30 months of metronomic treatment revealed stable disease, with very high avidity on both 18 F-f luorodeoxyglucose (fdg) positron-emission tomography (pet) and 18 Ffluorothymidine (flt) pet (Figure 1). ABSTRACT BackgroundChildren with high-grade glioma still have a poor prognosis despite the use of multimodal therapy including surgery, radiotherapy, and chemotherapy. New therapeutic strategies and methods evaluating such therapies are needed. ObservationHere we describe a child with anaplastic oligodendroglioma of the spinal cord who was unable to tolerate standard chemoradiotherapy and who had still-vital residual tumour during therapy. A good response was obtained with low-dose metronomic treatment containing vinblastine. The treatment was guided according to gradual response assessed using various positron-emission tomography tracers. ConclusionsMetronomic treatment guided by positron-emission tomography could be a reasonable option in some high-risk pediatric tumours.

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Section: Case Descriptionmentioning

confidence: 99%

Successful Use of Metronomic Vinblastine and Fluorothymidine pet Imaging for the Management of Intramedullary Spinal Cord Anaplastic Oligoastrocytoma in a Child

et al. 2014

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“…[17] Erişkin GBM'li hastalarda Temozolomide'nin (TMZ) etkinliği gösterildikten sonra, birçok pediatrik çalışma bu tedavi protokolünü denemiş ancak benzer yaşam sürelerini gösterememiştir. [18][19][20] St Jude Çocuk Hastanesi'nde (SJHG98 study) yapılan çalışmada RT sırasında ve sonrasında TMZ verilen 31 yeni tanılı YDG'lu çocukta (GBM=15; AA=10; diğer YDG=4), 2 yıllık OS ve yaşam sü-resi sırasıyla %11±%5 ve %21 ±%7 olarak sonuç-lanmıştır. [19] COG'nin yeni tanılı YDG'lu hastalarda yaptğı en kapsamlı çalışmada (ACNS0126 çalışması), 99 hastaya (55 GBM, 31 AA ve 4 diğer YDG), RT (54Gy+boost 5.4 Gy) sırasında TMZ (90 mg/m 2 /g 42 gün) ve 4 hf dinlenme sonrasında TMZ 200 mg/m 2 /g x 5 g 28 g bir x 10 kür uygulanmıştır.…”

Section: Yüksek Dereceli Gliom Tedavisiunclassified

“…[19] COG'nin yeni tanılı YDG'lu hastalarda yaptğı en kapsamlı çalışmada (ACNS0126 çalışması), 99 hastaya (55 GBM, 31 AA ve 4 diğer YDG), RT (54Gy+boost 5.4 Gy) sırasında TMZ (90 mg/m 2 /g 42 gün) ve 4 hf dinlenme sonrasında TMZ 200 mg/m 2 /g x 5 g 28 g bir x 10 kür uygulanmıştır. [20] CCG-945 çalışmasıyla karşılaştırıldı-ğında üç yıllık OS ve yaşam süreleri bakımından aralarında hiçbir fark bulunamamıştır. Ancak AA'lı hastaların üç yıllık OS süresinin GBM'li hasta grubuna göre daha uzun olduğu görülmüştür.…”

Section: Yüksek Dereceli Gliom Tedavisiunclassified

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Treatment of high-grade glioma in children

Cakir¹

2013

TJ Oncol

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“…Unfortunately, this knowledge has not resulted in a change of therapeutic approach and there is a lack of new agents for the treatment of these cancers. Only a few new agents have been approved for general use (55)(56)(57), and for some of these, such as temozolomide and bevacizumab, the results in children have been disappointing (58,59). We will outlay here some of the CSC-specific novel approaches and preclinical experiments that will hopefully lead to new therapies for children with neural tumors.…”

Section: Csc Therapiesmentioning

confidence: 99%