Temozolomide as salvage treatment for recurrent intracranial ependymomas of the adult: a retrospective study.

Abstract

BACKGROUND:

Few data are available on temozolomide (TMZ) in ependymomas.We investigated the response, survival, and correlation with MGMT promoter methylation in a cohort of patients with adult intracranial ependymoma receiving TMZ as salvage therapy after failure of surgery and radiotherapy.

PATIENTS AND METHODS:

We retrieved clinical information from the institutional database and follow-up visits, and response to TMZ on MRI was evaluated according to the MacDonald criteria.

RESULTS:

Eighteen patients (median age, 42 y), with either WHO grade III (10) or grade II (8) ependymoma were evaluable. Tumor location at diagnosis was supratentorial in 11 patients and infratentorial in 7. Progression before TMZ was local in 11 patients, local and spinal in 6 patients, and spinal only in one patient. A median of 8 cycles of TMZ (1-24) was administered. Response to TMZ consisted of complete response (CR) in one (5%) patient, partial response (PR) in 3 (17%) patients, stable disease (SD) in 7 (39%) patients, and progressive disease (PD) in 7 (39%) patients. Maximum response occurred after 3, 10, 14, and 15 cycles, respectively, with neurological improvement in 2 patients. All 4 responding patients were chemotherapy naïve. Both anaplastic (2) and grade II (2) tumors responded. Median progression-free survival and overall survival were 9.69 months (95% CI, 3.22-30.98) and 30.55 months (95% CI, 12.85-52.17), respectively. MGMT methylation was available in 11 patients and was not correlated with response or outcome.

CONCLUSION:

TMZ has a role in recurrent chemo-naïve adult patients with intracranial ependymoma, regardless of tumor grade and MGMT methylation. We suggest that, after failure of surgery and radiotherapy, TMZ should be considered as a possible first-line treatment for recurrent ependymoma.

• Authors: Roberta Rudà, Chiara Bosa, Michela Magistrello, Federica Franchino, Alessia Pellerino, Valentina Fiano, Morena Trevisan, Paola Cassoni, Riccardo Soffietti
• Journal: Neuro-oncology (Neuro Oncol) Vol. 18 Issue 2 Pg. 261-8 (Feb 2016) ISSN: 1523-5866 [Electronic] England
• PMID: 26323606 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2015. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Antineoplastic Agents, Alkylating
• Dacarbazine
• Temozolomide

Topics

• Adolescent
• Adult
• Antineoplastic Agents, Alkylating (therapeutic use)
• Brain Neoplasms (drug therapy, pathology)
• Dacarbazine (analogs & derivatives, therapeutic use)
• Ependymoma (drug therapy, pathology)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Grading
• Neoplasm Recurrence, Local (drug therapy, pathology)
• Prognosis
• Retrospective Studies
• Salvage Therapy
• Survival Rate
• Temozolomide
• Young Adult