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Adjuvant chemotherapy after severe myelotoxicity during chemoradiation phase in malignant gliomas. Is it feasibile? Results from AINO study (Italian Association for Neuro-Oncology)

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Abstract

Background

Malignant gliomas (MG) are aggressive brain tumours in adults. The standard of care is concurrent radiation plus temozolomide (TMZ) [chemo-radiotherapy (CRT)] followed by TMZ maintenance up to 6 months. TMZ is considered to have a low toxicity profile, but several studies reported occurrence of severe myelosuppression, especially during the concomitant phase. Toxicity may be prolonged, thus treatment should be discontinued.

Purpose

To evaluate the risk of recurrente myelotoxicity during adjuvant chemotherapy (CT) in patients who recovered from severe myelotoxicity during CRT.

Methods

We retrospectively collected data on patients with MG who developed and recovered from severe myelotoxicity during CRT from eight Italian neuro-oncology centers.

Results

We included 87 patients. Histology was Glioblastoma (GBM) in 78 patients (89.7%); 60% of patients were female. After myelotoxicity recovery, 54 (62%) received treatment. The majority of them (82%, n = 44) received adjuvant TMZ and 18% (n = 10) others treatments. Out of 44 patients who received adjuvant TMZ, 34% experienced the re-occurrence of grade 3–4 myelotoxicity which required permanent CT discontinuation in 6 (13%) cases. Patients who received TMZ or other treatments had longer overall (OS) (adjusted HR 0.46, p = 0.008) and progression free survival (PFS) (adjusted HR 0.57, p = 0.034) than those who remained untreated.

Conclusion

Our study suggests that after severe myelotoxicity the majority of patients received treatment, particularly with TMZ. Only a fraction of patients experienced toxicity recurrence, suggesting that TMZ is well tolerated and had an impact on PFS and OS.   

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [V.V.]. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

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Funding

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Author information

Authors and Affiliations

  1. Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy

    Veronica Villani & Andrea Pace

  2. Molecular Neuroncology Unit Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy

    Elena Anghileri

  3. Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy

    Luca Prosperini

  4. Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy

    Giuseppe Lombardi

  5. Department of Neuro-Oncology, City of Health and Science Hospital, Turin, Italy

    Roberta Rudà & Edoardo Pronello

  6. Neuro-Oncology Unit Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy

    Paola Gaviani & Giorgia Simonetti

  7. Department of Oncology, Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy

    Simona Rizzato & Giada Targato

  8. Oncology Department, Istituto Neurotraumatologico Italiano, Grottaferrata, RM, Italy

    Gaetano Lanzetta

  9. Phase 1 Unit and Precision Medicine-IRCSS Regina Elena National Cancer Institute, Rome, Italy

    Alessandra Fabi

  10. Radiation Oncology Unit, UPMC Hillman Cancer Center, San Pietro Hospital FBF, Rome, Italy

    Claudia Scaringi

  11. Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Neuromed, Pozzilli, Italy

    Gaetano Lanzetta

Authors
  1. Veronica Villani
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  2. Elena Anghileri
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  3. Luca Prosperini
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  4. Giuseppe Lombardi
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  11. Edoardo Pronello
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  13. Giada Targato
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  14. Andrea Pace
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Contributions

Conception and design of study: VV, AP. Acquisition data: AP, AF, GL, RR, PG, SR, LG, CS, EP, GS, GT. Data analysis: LP. Interpretation: AE, VV, AP. Drafting: VV, LP. Revising: AE, AP. Final approval: VV, AP. All authors read and approved submission.

Corresponding author

Correspondence to Veronica Villani.

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Conflicts of interest

The author declares that they have no conflict of interest.

Consent to participate

Informed consent, in line with the principles of the Declaration of Helsinki, was obtained from all individual participants included in the study.

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Villani, V., Anghileri, E., Prosperini, L. et al. Adjuvant chemotherapy after severe myelotoxicity during chemoradiation phase in malignant gliomas. Is it feasibile? Results from AINO study (Italian Association for Neuro-Oncology). J Neurol 268, 2866–2875 (2021). https://doi.org/10.1007/s00415-021-10438-4

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  • DOI: https://doi.org/10.1007/s00415-021-10438-4

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