Abstract 275P
Background
Current treatment for primary central nervous system lymphoma involves high-dose methotrexate based regimen. In low&middle-income countries like Vietnam, a shortage of drugs and monitoring is common. The present study reports the first experience and preliminary results of 25 patients PCNSL treated with HD-MTX and RTX.
Methods
Following Institutional Review Board approval by Vietnam National Institute for Cancer Control, a prospective study evaluating the treatment of histologically confirmed PCNSL with combined biweekly HD-MTX (8g/m2/dose) and weekly RTX (375 mg/m2/dose) for 8 cycles. Responders received consolidation treatment with 2 additional cycles, followed by maintenance with monthly HD-MTX for up to 12 months. Patients received aggressive hydration infusion to maintain a urine output of ≥ 100 ml/h and a urinary pH of > 7, until serum MTX levels had decreased to ≤ 0.1 µM/l. Serum MTX levels were monitored daily. Leucovorin rescue was initiated 24 h after completion of MTX infusion and administered at 50 mg IV every 6 h for the first 4 doses and then 30 mg IV until serum MTX levels were ≤0.1 µM/l. Leucovorin dosing was increased in cases of slow MTX clearance. The primary end point was radiographic response, and drug-related toxicity and secondary were survival.
Results
From 01/2017 to 12/2018, 25 patients were analysed (13 males and 12 females, median age 58.6). Following a mean of 10,72 cycles, the response rate and CR rate was 88% and 36%. The median PFS was 13 months and the OS has not yet been attained. MTX clearance was achieved by 72h in 198/268 cycles, and by 96h in 92%; 30.9% cycles needed escalation of leucovorin rescue dose. Toxicity: transient transaminitis (72%), mucotitis (59%) and diarhea (61.9%), febrile neutropenia (8%). Pneumonia was observed in 2 patients. 4 patients had renal dysfunction and 2 patient had dialysis.
Conclusions
RTX combined HDMTX for PCNSL is possible in lower-middle income countries like Vietnam but should be done in experienced centers capable of close monitoring serum MTX levels to prevent toxicity. The addition of RTX to HD-MTX in the treatment of PCNSL may increase response rates and prolong PFS. The final results currently in progress will more definitively estimate the survival.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
9P - XRCC1 Arg194Trp, Palb2 T1100T (3300T>G), HMMR V353A, TNF aG308A polymorphisms as diagnostic and prognostic markers of breast cancer in the Kyrgyz ethnic group
Presenter: Aigul Semetei kyzy
Session: Poster display session
Resources:
Abstract
232P - Early Results from the Phase I Study of SY-1365, a Potent and Selective CDK7 inhibitor, in Patients with Ovarian Cancer and Advanced Solid Tumors
Presenter: Debra Richardson
Session: Poster display session
Resources:
Abstract
382P - Drug metabolizing enzymes pharmacogenomic: Biomarkers for improved chemotherapy in head and neck cancer squamous cell carcinoma
Presenter: Sunishtha Bhatia
Session: Poster display session
Resources:
Abstract
401P - Women in oncology: Alarming figures from India
Presenter: Sharada Mailankody
Session: Poster display session
Resources:
Abstract
416P - Multidisciplinary management of sarcomas of the head and neck: An institutional experience
Presenter: Kavitha Jain
Session: Poster display session
Resources:
Abstract
523P - Co-morbilities and survival of patients initially diagnosed with extensive-stage small cell lung cancer: Impact of hypertension, diabetes and chronic hepatitis B viral infection
Presenter: Weigang Xiu
Session: Poster display session
Resources:
Abstract
529P - Osimertinib for patients with EGFR-mutant advanced NSCLC and asymptomatic brain metastases: An open-label, two-arm, phase II study
Presenter: Roni Gillis
Session: Poster display session
Resources:
Abstract