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 Cytotoxic agents
Central Nervous System Malignancies
Therapy
Biological therapy
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.