Efficacy of temozolomide for recurrent embryonal brain tumors in children.

Abstract

OBJECTIVE:

The salvage therapy of recurrent embryonal brain tumors in children is disappointing. Temozolomide is a newly developed chemotherapeutic agent in central nervous system tumors. This study analyzed the efficacy of temozolomide on the treatment of recurrent embryonal brain tumors in children.

MATERIALS AND METHODS:

There were eight patients, including four with medulloblastoma (MB), three with atypical teratoid/rhabdoid tumor (AT/RT) and one with supratentorial primitive neuroectodermal tumor, whose tumors recurred after surgery and radiotherapy, with or without conventional intravenous cisplatin-based chemotherapy. They all received once daily oral temozolomide (150 mg/m(2)/day) for five consecutive days in a 28-day cycle. The responsiveness of the tumors to temozolomide was judged by magnetic resonance imaging (MRI) during regular follow-up.

RESULTS:

The median treatment cycles received by these eight patients were 17 (range from two to 59 cycles). The follow-up MRI showed no tumor progression in five patients at 6 months and four patients at 12 months. The median progression-free survival (PFS) of the eight patients was 15.7 months (range from 0 to 59 months). Complete response was achieved in one patient with MB accompanying with a long period of PFS for 26 months. Another patient with AT/RT showed partial response accompanying with a long period of PFS for 59 months. The observed adverse effects of temozolomide included nausea, vomiting, headache, constipation, mild marrow suppression, and decreased activity; none of them was severe enough to discontinue the treatment. No patient experienced moderate or severe marrow suppression in this series.

CONCLUSION:

In this preliminary study, oral temozolomide shows promising results on recurrent embryonal brain tumors in children. The adverse effects of temozolomide are mild and tolerable. When conventional chemotherapy fails and/or the adverse response is too severe to tolerate, temozolomide is a reasonable alternative. However, a further well-designed, controlled study and more long-term follow-up are needed to assess the exact role of temozolomide in children with embryonal tumors in brain.

• Authors: Chung-Hao Wang, Ting-Rong Hsu, Tai-Tong Wong, Kai-Ping Chang
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 25 Issue 5 Pg. 535-41 (May 2009) ISSN: 1433-0350 [Electronic] Germany
• PMID: 19107490 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents, Alkylating
• Dacarbazine
• Temozolomide

Topics

• Administration, Oral
• Adolescent
• Antineoplastic Agents, Alkylating (administration & dosage, adverse effects, therapeutic use)
• Brain Neoplasms (drug therapy)
• Dacarbazine (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Headache (chemically induced)
• Humans
• Magnetic Resonance Imaging
• Male
• Medulloblastoma (drug therapy, radiotherapy, surgery)
• Nausea (chemically induced)
• Neuroectodermal Tumors, Primitive (drug therapy, radiotherapy, surgery)
• Rhabdoid Tumor (drug therapy, radiotherapy, surgery)
• Temozolomide
• Teratoma (drug therapy, radiotherapy, surgery)
• Treatment Outcome
• Vomiting (chemically induced)