Abstract 3302
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
| PCV | TMZ | p value | |
|---|---|---|---|
| Median age (years) | 57 (range 29-71) | 63 (range 34-80) | 0.119 |
| Excision | 0.613 | ||
| Debulking | 25(80,6%) | 13(86,7%) | |
| Biopsy | 6(19,4%) | 2(19.4%) | |
| Radiological Appearacne | 0.182 | ||
| Single | 24(77,4%) | 14(93.3%) | |
| Multifocal | 7(22.4%) | 1(6.7%) | |
| Adjuvant Treatment | 0.816 | ||
| Radical chemo-RT | 25(80.6%) | 13(86.7%) | |
| Radical RT alone | 2(6.5%) | 1(6.7%) | |
| Palliative RT | 4(12.9%) | 1(6.7%) | |
| Adjuvant treatment completed within 6 months | 1 (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.