575P - Temozolomide for concurrent therapy in brain metastases: Is it feasible in a developing country?

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Central Nervous System Malignancies
Presenter Mahalaxmi Aal
Citation Annals of Oncology (2016) 27 (suppl_9): ix184-ix189. 10.1093/annonc/mdw603
Authors M. Aal, V.B. Lakshman, N. Hanumanthappa, Y. Shivashankara, P. Venkatram Kumar, S. Prabaharan, R. Kumar
  • Radiation Oncology, HCG Bangalore Institute of Oncology Speciality Centre, 560027 - Bangalore/IN

Abstract

Background

Whole Brain Radiotherapy (WBRT) is the treatment of choice for patients with multiple symptomatic brain metastases. Although WBRT is effective with regard to improvement of neurologic symptoms, patients with brain metastases in addition to systemic disease may require additional therapies to achieve significant improvements in overall response. Studies combining temozolomide (TMZ) with whole brain radiotherapy reported more favourable response. With this background we conducted a prospective comparison trial using concurrent TMZ in patients with whole brain metastases along with radiotherapy to assess the feasibility of concurrent TMZ in our set up as compared to WBRT alone.

Methods

Sixty four patients with clinically diagnosed and radiologically proven brain metastases between the ages of 18-75 years with KPS score of ≥ 70 were recruited from September 2014 to December 2015. Patients were divided into two arms. Arm A patients received WBRT of 30Gy in 10 fractions using 3DCRT technique over two weeks along with concurrent TMZ 75mg/m2, 5 days a week, for 2 weeks. Arm B patients received WBRT of 30Gy in 10 Fractions using 3DCRT technique alone over 2 weeks, 5 days a week. All patients underwent MRI scan of Brain at diagnosis and at 90 days after completion of radiotherapy to assess radiological response.

Results

Response rates noted in the WBRT + TMZ group compared to WBRT alone was stable disease (15.6% Vs 0%), partial response (84.4% Vs 87.5%), progressive disease (0% Vs 12.5%) respectively, with a statistically significant p value of 0.011. The most common primary site was lung (53%) with response rates of stable disease, (16.6 Vs 0%) partial response (83% Vs 93.75%) and none with progressive disease. The next common primary site was breast (32.8%) with response rates of stable disease (10%Vs 0%), partial response (90%Vs 81.8%) and progressive disease (0 Vs 18.2%)

Conclusions

There was statistically significant difference in the objective response rate in the group of patients who received WBRT with concurrent TMZ as compared to those who received WBRT alone. We confirm that the combined treatment of WBRT with TMZ is safe and well tolerated with no treatment interruptions.

Clinical trial indentification

EC/213/15/01

Legal entity responsible for the study

HCG-Central Ethics Comittee, REG.NO.:ECR/386/INST/KA2013

Funding

Health Care Global Enterprises Limited Bangalore

Disclosure

All authors have declared no conflicts of interest.