Clinical Study – Patient Study

Journal of Neuro-Oncology

, Volume 106, Issue 2, pp 391-397

Treatment of recurrent diffuse intrinsic pontine glioma: the MD Anderson Cancer Center experience

  • Johannes E. WolffAffiliated withDepartment of Pediatrics, The University of Texas M. D. Anderson Cancer CenterDepartment of Biostatistics, M. D. Anderson Cancer CenterDepartment of Pediatrics, Tufts Medical Center Email author 
  • , Michael E. RyttingAffiliated withDepartment of Pediatrics, The University of Texas M. D. Anderson Cancer Center
  • , Tribhawan S. VatsAffiliated withDepartment of Pediatrics, The University of Texas M. D. Anderson Cancer Center
  • , Peter E. ZageAffiliated withDepartment of Pediatrics, The University of Texas M. D. Anderson Cancer CenterDepartment of Pediatric Oncology, Texas Children’s Hospital
  • , Joann L. AterAffiliated withDepartment of Pediatrics, The University of Texas M. D. Anderson Cancer Center
  • , Shiao WooAffiliated withDepartment of Radiation Oncology, Kosair Children’s Hospital/Norton Healthcare University of Louisville School of Medicine
  • , John KutteschAffiliated withPediatrics/Hematology/Oncology—H085, Penn State Hershey Children’s Hospital
  • , Leena KetonenAffiliated withDepartment of Diagnostic Imaging, M. D. Anderson Cancer Center
  • , Anita MahajanAffiliated withDepartment of Radiation Oncology, M. D. Anderson Cancer Center

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Abstract

Recurrent diffuse intrinsic pontine gliomas (DIPG) are traditionally treated with palliative care since no effective treatments have been described for these tumors. Recently, clinical studies have been emerging, and individualized treatment is attempted more frequently. However, an informative way to compare the treatment outcomes has not been established, and historical control data are missing for recurrent disease. We conducted a retrospective chart review of patients with recurrent DIPG treated between 1998 and 2010. Response progression-free survival and possible influencing factors were evaluated. Thirty-one patients were identified who were treated in 61 treatment attempts using 26 treatment elements in 31 different regimens. The most frequently used drugs were etoposide (14), bevacizumab (13), irinotecan (13), nimotuzumab (13), and valproic acid (13). Seven patients had repeat radiation therapy to the primary tumor. Response was recorded after 58 treatment attempts and was comprised of 0 treatment attempts with complete responses, 7 with partial responses, 20 with stable diseases, and 31 with progressive diseases The median progression-free survival after treatment start was 0.16 years (2 months) and was found to be correlated to the prior time to progression but not to the number of previous treatment attempts. Repeat radiation resulted in the highest response rates (4/7), and the longest progression-free survival. These data provide a basis to plan future clinical trials for recurrent DIPG. Repeat radiation therapy should be tested in a prospective clinical study.

Keywords

Diffuse intrinsic pontine glioma Chemotherapy Radiation Biomathematics