NEW YORK (Reuters Health), Apr 13 - Intensive treatment with a combination of lomustine, temozolomide, and radiotherapy can achieve long-term survival in patients newly diagnosed with glioblastoma, German and Swiss researchers report in the March 10 issue of the Journal of Clinical Oncology.
"We have markedly improved survival in a subgroup of patients with glioblastoma," senior investigator Dr. Ulrich Herrlinger told Reuters Health, "and see a way to further extend survival by optimizing combination chemotherapy in this group of patients."
Herrlinger of the University of Bonn and colleagues studied 39 patients who underwent radiotherapy. Of these, 31 were treated with standard doses of lomustine and temozolomide. The remaining eight patients received doses of lomustine that were 10% higher and temozolomide doses that were 50% higher.
Overall, median survival was 23.1 months; 47.4% of the patients survived for two years, and 18.5% survived for four years.
After a median follow-up of 41.5 months, this end point had not been reached in the intensified therapy subgroup. Four of these patients survived for at least 56 months and two did so with no recurrence.
The team also established that methylation of the DNA repair gene MGMT promotor was associated with a reduced mortality (relative risk, 0.43), as was intensified chemotherapy (relative risk, 0.37).
WHO grade 4 hemotoxicity was seen more often in the intensified treatment group (57%) than in those given standard chemotherapy (16%). No nonhematologic toxicities were observed.
These findings, the researchers conclude, "demonstrate an encouraging therapeutic potential but also demonstrate the toxic limitations of the dose-intensified regimen in this setting."
By David Douglas
J Clin Oncol 2009;27:1257-1261.
Last Updated: 2009-04-10 12:28:52 -0400 (Reuters Health)
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