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Our doctors are happy to discuss your individual case with you. Serious inquiries only, please. To request an initial
team consultation, call Dr. Arenson, For more information
about CNI's Brain & Spinal Tumor Team, |
On May 5-8, 2005, Dr. Edward Arenson, medical director of the CNI Center for Brain & Spinal Tumors, presented at the 2nd Quadrennial Meeting of the World Federation of NeuroOncology (WFNO), 6th Meeting of the European Association for NeuroOncology, in Edinburgh, Scotland. Below is the abstract of his paper:
Encouraging results for a novel chemotherapeutic regimen in newly diagnosed glioblastoma multiforme
Arenson, E., Bank, J., Pierick, M., Greenwald, C., Fullagar, T., and McVicker, J. from the Colorado Neurological Institute and Swedish Medical Center, Englewood, CO, USA.
Substantial benefit from chemotherapy of cancer requires effective combinations;
nevertheless, monotherapy with temozolomide (TMZ) has emerged as the “standard”
treatment of glioblastoma multiforme (GBM). We report results of treatment
of GBM with the novel combination of BCNU, irinotecan (CPT11) and TMZ
(BITE). Four patients were excluded from this treatment because of: expected
survival < 3 months, absence of caregiver or 24 hour care requirement.
Thirty-seven patients with newly diagnosed GBM were treated between August,
1999 and October, 2002. Mean age was 53.4 years. Thirteen patients had
bilateral and/or multifocal disease. Nine had gross total resection, 27
subtotal resection and 1 biopsy, as determined by early post-operative
contrast MRI. Treatment consisted of three courses of CPT11 (400 mg/m2
x 1) and TMZ (200 mg/m2 x 5) given every 21 days during standard radiotherapy
(RT) (phase I) to which BCNU (40 mg/m2 x 3) was added after RT for up
to 6 monthly courses as tolerated (phase II). Three patients did not complete
phase I because of patient choice, neurological decline or death from
intratumoral hemorrhage unrelated to treatment. Two additional patients
did not proceed to phase II because of poor performance status. Thirty-two
patients received 115 courses of BITE (mean 3.4) and had episodes of grade
III/IV toxicities as follows: GI 12%, neutropenia 42% and thrombocytopenia
11%. There were 2 deaths during phase II unrelated to disease progression:
one disseminated CMV and one bacterial pneumonia. One patient survived
an atypical mycobacterial pneumonitis, and one survived an episode of
BCNU pneumonitis. With minimum follow-up of 30 months, mean survival is
19 months. Overall survival is 59% 1-year, 30% 2-year, 19% 3-year, and
relapse-free survival is 46% 1-year, 22% 2-year and 11% 3-year. Six patients
are alive (16%), five without evidence of disease and one with stable
disease from 37 to 48 months post diagnosis. For patients with initial
gross total resection (24%), relapse-free survival was 67% 1-year, 33%
2-year and 11% 3-year. We conclude that: 1. BITE is toxic, but effective
2. polychemotherapy should not be abandoned in GBM 3. BITE deserves further
study with efforts to reduce toxicity 4. patients with gross total resection
may survive long-term with aggressive post-surgical treatment.
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Colorado Neurological
Institute Center for Brain & Spinal Tumors
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