Temozolomide salvage chemotherapy for recurrent anaplastic oligodendroglioma and oligo-astrocytoma

Abstract

Objective: To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA).

Methods: A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 mg/m(2)/day) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed.

Results: TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (≥grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient's histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01).

Conclusion: For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.

Keywords: Anaplastic oligoastrocytoma; Anaplastic oligodendroglioma; Chemotherapy; Recurrence; Temozolomide.

Fig. 1

Kaplan-Meier progression-free survival in patients with recurrent AO or AOA after salvage TMZ chemotherapy (A) according to histopathology (AO vs. SOA, p>0.05) and (B) time to recurrence after the initial treatment for AO/AOA (<1 year vs. ≥1 year, p=0.04). AO : anaplastic oligodendroglioma, AOA : anaplastic oligo-astrocytoma, TMZ : temozolomide.

Fig. 2

Kaplan-Meier overall survival in patients with recurrent AO or AOA after salvage TMZ chemotherapy (A) according to histopathology (AO vs. AOA, p>0.05) and (B) ECOG performance status (0-1 vs. 2-3, p=0.007). AO : anaplastic oligodendroglioma, AOA : anaplastic oligo-astrocytoma, TMZ : temozolomide.