Clinical Study

Journal of Neuro-Oncology

, Volume 115, Issue 1, pp 71-77

First online:

Retrospective study of pemetrexed as salvage therapy for central nervous system lymphoma

  • Jun-Ping ZhangAffiliated withDepartment of Neuro-Oncology, Beijing Sanbo Brain Hospital, Capital Medical University
  • , Eudocia Q. LeeAffiliated withCenter for Neuro-Oncology, Dana Farber/Brigham and Women’s Cancer Center
  • , Lakshmi NayakAffiliated withCenter for Neuro-Oncology, Dana Farber/Brigham and Women’s Cancer Center
  • , Lisa DohertyAffiliated withCenter for Neuro-Oncology, Dana Farber/Brigham and Women’s Cancer Center
  • , Santosh KesariAffiliated withDepartment of Neurosciences, Center for Translational Neuro-Oncology, UC San Diego
  • , Alona MuzikanskyAffiliated withDepartment of Biostatistics, Massachusetts General Hospital
  • , Andrew D. NordenAffiliated withCenter for Neuro-Oncology, Dana Farber/Brigham and Women’s Cancer Center
  • , Huichao ChenAffiliated withDepartment of Biostatistics, Harvard School of Public Health
  • , Patrick Y. WenAffiliated withCenter for Neuro-Oncology, Dana Farber/Brigham and Women’s Cancer Center
    • , Jan DrappatzAffiliated withDivision of Hematology and Oncology, Departments of Neurology and Medicine, University of Pittsburgh Medical Center Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

There is currently no standard therapy for recurrent or chemotherapy-refractory central nervous system lymphoma (CNSL). Pemetrexed has been reported to have activity in patients with primary CNSL (PCNSL). The use of pemetrexed in secondary CNS lymphoma (SCNSL) has not previously been reported. Here we retrospectively review the outcomes and toxicities of standard and modified doses of pemetrexed as salvage therapy in 18 PCNSL and 12 SCNSL patients. The overall response rate for PCNSL patients was 64.7 %, all of whom achieved a complete response (CR). The median progression-free survival (PFS) was 5.8 months. For the SCNSL patients, RR was 58.3 % with 2 CR (16.7 %); the median PFS was 2.5 months. Grade ≥3 adverse events included leukopenia in 5 patients (16.7 %), neutropenia in 1 patient (3.3 %), and fatigue in 3 patients (10.0 %). 3 patients died while on treatment, 2 due to infections and 1 due to pulmonary embolism. Our results indicate that pemetrexed has activity as salvage therapy in recurrent PCNSL, even with modified dosing, but outcomes trend towards less favorable in SCNSL.

Keywords

Pemetrexed Primary central nervous system lymphoma Secondary central nervous system lymphoma Salvage chemotherapy