International Journal of Hematology and Oncology
2023, Vol 33, Num 4 Page(s): 178-183
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Combination of Cyclophosphamide and Carboplatin in Recurrent Malignant Gliomas
Umut DEMIRCI1, Suleyman BUYUKBERBER2, Nuriye OZDEMIR3, Ugur COSKUN2, Halit KARACA4, Muge AKMANSU5, Emel YAMAN6, Meltem BAYKARA2, Deniz YAMAC2, Aytug UNER2, Mustafa BENEKLI2
1Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, TURKEY
2Gazi University Faculty of Medicine, Department of Medical Oncology, Ankara, TURKEY
3Numune Training and Research Hospital, Department of Medical Oncology, Ankara, TURKEY
4Erciyes University Faculty of Medicine, Department of Medical Oncology, Kayseri, TURKEY
5Gazi University Faculty of Medicine, Department of Radiation Oncology, Ankara, TURKEY
6Mersin State Hospital, Department of Medical Oncology, Mersin, TURKEY
Keywords: Malignant glioma, Recurrent, Cyclophosphamide, Carboplatin
Eventually, all patients with malignant gliomas recur or progress. Unfortunately, the optimal regimen in the salvage setting has not yet been defined. We retrospectively evaluated 52 patients with malignant gliomas who failed temozolomide therapy and were treated with a combination of intravenous carboplatin and oral cyclophosphamide. The median age of all patients, including those with glioblastoma multiforme (GBM) (n= 40) and anaplastic glioma (AG) (n= 12), was 45.5 years (range 23-68). All patients were treated with consolidation temozolomide after chemoradiotherapy. After temozolomide failure, second surgery was performed on 15, reirradiation on four and radiosurgery on three patients. The median number of chemotherapy cycles was 4 (range 1-8), the clinical benefit was 67.3%, a partial response was achieved in 26.9% and stable disease in 40.4%. In the GBM group, median progressionfree survival (PFS) and overall survival (OS) were 3 (95% CI, 2.31-3.69) and 8 (95% CI, 4.76-11.24) months, respectively. In the AG group, median PFS and OS were 5 (95% CI, 3.51-6.49) and 11 (95% CI, 6.38-15.62) months, respectively. The six-month PFS rate was 25%. Only one patient survived 18 months after treatment. Serious toxicity was mainly hematological.
The combination of carboplatin and oral cyclophosphamide is a valuable option in temozolomide refractory patients with malignant glioma.
Umut DEMIRCI1, Suleyman BUYUKBERBER2, Nuriye OZDEMIR3, Ugur COSKUN2, Halit KARACA4, Muge AKMANSU5, Emel YAMAN6, Meltem BAYKARA2, Deniz YAMAC2, Aytug UNER2, Mustafa BENEKLI2
1Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, TURKEY
2Gazi University Faculty of Medicine, Department of Medical Oncology, Ankara, TURKEY
3Numune Training and Research Hospital, Department of Medical Oncology, Ankara, TURKEY
4Erciyes University Faculty of Medicine, Department of Medical Oncology, Kayseri, TURKEY
5Gazi University Faculty of Medicine, Department of Radiation Oncology, Ankara, TURKEY
6Mersin State Hospital, Department of Medical Oncology, Mersin, TURKEY
Keywords: Malignant glioma, Recurrent, Cyclophosphamide, Carboplatin
Eventually, all patients with malignant gliomas recur or progress. Unfortunately, the optimal regimen in the salvage setting has not yet been defined. We retrospectively evaluated 52 patients with malignant gliomas who failed temozolomide therapy and were treated with a combination of intravenous carboplatin and oral cyclophosphamide. The median age of all patients, including those with glioblastoma multiforme (GBM) (n= 40) and anaplastic glioma (AG) (n= 12), was 45.5 years (range 23-68). All patients were treated with consolidation temozolomide after chemoradiotherapy. After temozolomide failure, second surgery was performed on 15, reirradiation on four and radiosurgery on three patients. The median number of chemotherapy cycles was 4 (range 1-8), the clinical benefit was 67.3%, a partial response was achieved in 26.9% and stable disease in 40.4%. In the GBM group, median progressionfree survival (PFS) and overall survival (OS) were 3 (95% CI, 2.31-3.69) and 8 (95% CI, 4.76-11.24) months, respectively. In the AG group, median PFS and OS were 5 (95% CI, 3.51-6.49) and 11 (95% CI, 6.38-15.62) months, respectively. The six-month PFS rate was 25%. Only one patient survived 18 months after treatment. Serious toxicity was mainly hematological.
The combination of carboplatin and oral cyclophosphamide is a valuable option in temozolomide refractory patients with malignant glioma.
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