Journal of Neuro-Oncology

, Volume 112, Issue 2, pp 209–215

“One week on–one week off”: efficacy and side effects of dose-intensified temozolomide chemotherapy: experiences of a single center

Authors

    • Department of NeurologyUniversity of Cologne
    • Institute of Neuroscience and Medicine, Research Center Juelich
  • Theresa Berhorn
    • Department of NeurologyUniversity of Cologne
  • Tobias Blau
    • Department of NeuropathologyUniversity of Cologne
  • Veronika Dunkl
    • Department of NeurologyUniversity of Cologne
  • Gereon R. Fink
    • Department of NeurologyUniversity of Cologne
    • Institute of Neuroscience and Medicine, Research Center Juelich
  • Michael Schroeter
    • Department of NeurologyUniversity of Cologne
Clinical Study

DOI: 10.1007/s11060-013-1048-z

Cite this article as:
Galldiks, N., Berhorn, T., Blau, T. et al. J Neurooncol (2013) 112: 209. doi:10.1007/s11060-013-1048-z

Abstract

To evaluate in a single center retrospectively the efficacy and tolerability of a weekly regimen, which alternates temozolomide (TMZ) in patients with recurrent or progressive high-grade glioma (HGG). From January 2005 until June 2011, 54 patients with recurrent or progressive HGG were treated with TMZ 150 mg/m²/day on days 1–7 and 15–21 of a 28-day cycle (“one week on–one week off” scheme; TMZ 7/14) with individual dose adjustment depending on toxicity. The majority of patients (n = 48, 89 %) was treated at first tumor recurrence or progression. All patients had received prior radiotherapy with or without concomitantly administered TMZ and, optionally, adjuvant chemotherapy. After initiation of TMZ 7/14, MRI was obtained every 8–12 weeks. Tumor response or progression was assessed according to Macdonald criteria. Blood examinations were performed weekly. Toxicity was evaluated according to Common Terminology Criteria for Adverse Events (CTCAE; version 3.0). A total of 434 treatment weeks with TMZ 7/14 were delivered. The median number of treatment weeks was 7 (range, 1–41 weeks). No grade 4 hematological toxicity and no opportunistic infections occurred. Patients with neutropenia were not observed. Two patients developed grade 3 and 4 patients grade 2 leukocytopenia. Thrombocytopenia grade 3 and grade 2 occurred in 4 patients and 6 patients, respectively. The progression-free survival (PFS) rate at 6 months was 43 %. Median PFS from treatment initiation was 18 weeks (95 % CI, 14–22 weeks) and median overall survival (OS) was 37 weeks (95 % CI, 31–42 weeks). The rates for PFS and OS at 1 year were 24 and 28 %, respectively. Our data suggest that treatment with TMZ 7/14 is safe and effective in patients with recurrent or progressive HGG.

Keywords

MGMT depletionMGMT promoter methylationRe-challenge of temozolomide

Copyright information

© Springer Science+Business Media New York 2013