Craniospinal irradiation with concurrent temozolomide and nimotuzumab in a child with primary metastatic diffuse intrinsic pontine glioma

A compassionate use treatment

Bestrahlung der kraniospinalen Achse mit simultaner Gabe von Temozolomid und Nimotuzumab bei einem Kind mit primär metastasiertem diffus intrinsischem Ponsgliom

Ein individueller Heilversuch

Abstract

Primary metastatic diffuse intrinsic pontine glioma (DIPG) is relatively rare and associated with a dismal prognosis. Combining craniospinal irradiation (CSI) with concurrent temozolomide and nimotuzumab therapy may slightly improve tumor control and overall survival. However, little is known about the feasibility and toxicity of this treatment approach. Here, we describe the case of an 8-year-old girl with primary metastatic DIPG who received craniospinal radiotherapy, a local boost, and concurrent temozolomide and nimotuzumab treatment based on an individual therapy recommendation. Radiotherapy could be completed without any interruption. However, concurrent temozolomide had to be disrupted several times due to considerable acute myelotoxicity (grade III–IV).Maintenance immunochemotherapy could be started with a delay of 5 days and was performed according to treatment schedule. The disease could be stabilized for a few months. A routine MRI scan finally depicted disease progression 5.7 months after the start of irradiation. The patient died 1.9 months later.

Zusammenfassung

Primär metastasierte diffus intrinsische Ponsgliome (DIPG) sind relativ selten und mit einer infausten Prognose verbunden. Die Kombination einer Bestrahlung der kraniospinalen Achse mit simultanen Gaben von Temozolomid und Nimotuzumab kann möglicherweise die Tumorkontrolle und das Gesamtüberleben leicht verbessern. Allerdings weiß man wenig über die Durchführbarkeit dieses Ansatzes im Hinblick auf die zu erwartenden Toxizitäten. Wir beschreiben den Krankheitsverlauf eines 8 Jahre alten Mädchens mit primär metastasiertem diffus intrinsischen Ponsgliom, welches mit einer kraniospinalen Bestrahlung mit lokaler Dosisaufsättigung behandelt wurde. Simultan zur Radiatio erhielt das Kind gemäß einer individuellen Behandlungsempfehlung Temozolomid und Nimotuzumab. Die Bestrahlung konnte ohne Unterbrechung durchgeführt werden. Allerdings musste die simultane Chemotherapie mit Temozolomid mehrmals aufgrund höhergradiger Myelotoxizitäten (Grad III und IV) ausgesetzt werden. Eine Erhaltungschemoimmuntherapie konnte schließlich mit einer Verzögerung von 5 Tagen begonnen und ansonsten planmäßig durchgeführt werden. Es gelang, die Erkrankung für einige Monate zu stabilisieren. In einer Routine-Kernspintomographie wurde schließlich 5,7 Monate nach Bestrahlungsbeginn ein Progress diagnostiziert. Die Patientin verstarb 1,9 Monate später.

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Conflict of interests

On behalf of all authors, the corresponding author states that there is no conflict of interest. This report was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Correspondence to K. Müller.

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Authors’ contributions: KM was responsible for the collection of data and together with AOvB for the draft of the manuscript. CMK, HC, and DV were responsible for the treatment of the patient and the control of the documentation of the treatment and follow-up data. AOvB, AS, CS, MWM, and RDK critically evaluated and approved the manuscript. KM, AOvB, CMK, and RDK were responsible for the conception of the case report. All authors read and approved the final manuscript.

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Müller, K., Schlamann, A., Seidel, C. et al. Craniospinal irradiation with concurrent temozolomide and nimotuzumab in a child with primary metastatic diffuse intrinsic pontine glioma. Strahlenther Onkol 189, 693–696 (2013). https://doi.org/10.1007/s00066-013-0370-x

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Keywords

  • Case reports
  • Child
  • Neoplasm metastasis
  • Antibodies, monoclonal, humanized
  • Radiotherapy

Schlüsselwörter

  • Fallbericht
  • Kind
  • Neoplastie, Metastasierung
  • Humanisierte monoklonale Antikörper
  • Strahlentherapie