Two types of
chemotherapy used in the treatment of patients with
malignant glioma are
carboplatin and
Gliadel wafer [(3.85% 1,3-bis-(2-chloroethyl)-1-nitrosourea (
BCNU)]. To date there have been no published data examining their concurrent use in this disease. The purpose of this study was to evaluate
combination chemotherapy with
Gliadel wafer and
carboplatin in patients with high-grade,
malignant glioma. In this prospective phase I study, 16 patients underwent surgery,
Gliadel wafer implantation (up to 8 wafers), intravenous
carboplatin given postoperatively (day 3 or 4) at a dose escalation range of area under the curve (AUC)=2-6, and external beam radiation. Median age was 55 years (range 27-66 years). Fourteen (88%) patients had
glioblastoma multiforme and 2 (12%) had
anaplastic astrocytoma. Performance status was as follows: Eastern Cooperative Oncology Group (ECOG)=0 (2 patients), ECOG=1 (13 patients), and ECOG=2 (2 patients). Three patients were treated at each dosing level (AUC=2-6), and 4 patients were treated at an AUC=5.
Carboplatin was administered to all patients by postoperative day 4. Radiation was begun on day 14-36. No grade 3 or 4 toxicities were noted in this study. Median progression-free and overall survival was 266 and 679 days, respectively. We conclude that administering systemic
carboplatin is safe and well tolerated in the postoperative period immediately following resection and implantation of
Gliadel wafer for the treatment of
malignant glioma. Further evaluation in a phase II setting, at maximal
carboplatin dose to establish potential efficacy, with this combination is warranted.