350P - An individualized-approach to second-line systemic anti-cancer therapy for glioblastoma

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Anti-Cancer Agents & Biologic Therapy
Central Nervous System Malignancies
Presenter Pinelopi Gkogkou
Citation Annals of Oncology (2017) 28 (suppl_5): v109-v121. 10.1093/annonc/mdx366
Authors P. Gkogkou1, K.(. Geropantas1, T. Ajithkumar2
  • 1Oncology Department, Norfolk and Norwich University Hospital, NR4 7UY - Norwich/GB
  • 2Oncology Department, Cambridge University Hospitals NHS Foundation Trust, CB2 0QQ - Cambridge/GB

Abstract

Background

The optimal second-line systemic anti-cancer therapy (SACT) for recurrent inoperable glioblastoma (GBM) is not known. Generally, patients with a recurrence within 6 months of adjuvant temozolomide (TMZ) are treated with procarbazine/lomustine/vincristine (PCV) regimen and those with a recurrence at least 6 months after completion of TMZ are re-challenged with TMZ (rTMZ). The aim of this study is to evaluate the clinical outcomes of this individualized approach.

Methods

We treated 46 patients with second-line SACT for recurrent GB between 2009 and 2015. The Response Assessment in Neuro-Oncology (RANO) criteria were used to assess treatment response. The Kaplan-Meier method was used to calculate survival. Patient- and disease-related characteristics between the groups were compared using the Fisher exact test.

Results

31 patients received PCV and 15 patients received rTMZ (Table). The median progression-free (PFS) (3.4 months each) and overall survival (OS) (5.2 months vs. 5.3 months p = 0.482) from the start of second-line SACT were similar for both groups. Compared with the PCV group, the median PFS (19.6 months vs. 8.7 months, p = 0.001) and OS (28 months vs. 13.7 months, p = 0.001) calculated from the date of diagnosis were better for the rTMZ group. Toxicity was acceptable in both treatment groups.Table:

350P

PCVTMZp value
Median age (years)57 (range 29-71)63 (range 34-80)0.119
Excision0.613
Debulking25(80,6%)13(86,7%)
Biopsy6(19,4%)2(19.4%)
Radiological Appearacne0.182
Single24(77,4%)14(93.3%)
Multifocal7(22.4%)1(6.7%)
Adjuvant Treatment0.816
Radical chemo-RT25(80.6%)13(86.7%)
Radical RT alone2(6.5%)1(6.7%)
Palliative RT4(12.9%)1(6.7%)
Adjuvant treatment completed within 6 months1 (3%)11 (73%)0.001
Median time to progression after first-line (months)1.2 (range: 0.7-11.03)9.8 (range: 1-24.3)0.001

Conclusions

As the individualized approach of second-line SACT in recurrent GB leads to similar survival. Patients who recur more than 6 months after completion of primary chemo-radiotherapy generally have a better survival.

Clinical trial identification

Legal entity responsible for the study

Department of Radiation Oncology, Norfolk & Norwich University NHS Foundation Trust

Funding

None

Disclosure

All authors have declared no conflicts of interest.