Chemotherapy for anaplastic oligodendroglioma

Gregory Cairncross, David Macdonald, Samuel Ludwin, Donald Lee, Terrence Cascino, Jan Buckner, Dorcas Fulton, Edward Dropcho, David Stewart, Clifford Schold, Nancy Wainman, Elizabeth Eisenhauer

Research output: Contribution to journalArticle

406 Scopus citations

Abstract

Purpose: To examine the rate and duration of response of anaplastic oligodendrogliomas to a dose-escalated combination chemotherapy regimen consisting of procarbazine, lomustine (CCNU), and vincristine (PCV) and to evaluate the side effects of this treatment. Methods: In this single-arm multicentered phase II study, patients with measurable, newly diagnosed or recurrent, contrast-enhancing anaplastic oligodendrogliomas were treated with up to six cycles of PCV. Central pathology and radiology review were mandatory, and rigorous response criteria based on imaging were used. Results: Thirty-three patients entered the trial; nine were excluded subsequently, seven due to ineligible pathology. Eighteen of 24 eligible patients (75%) responded, nine completely (38%), four had stable disease (SD), and two progressed during the first cycle of PCV. Responses were observed in nine of 10 patients (90%) with a preexisting low-grade oligodendroglioma and 10 of 15 (67%) with necrotic tumors, called glioblastoma multiforme by some. Previously irradiated patients were as likely to respond to PCV as those newly diagnosed (11 of 15 [73%] v seven of nine [78%]). The median time to progression will be at least 25.2 months for complete responders, and was 14.2 months for partial responders and 6.8 months for stable patients. Four ineligible patients also responded to PCV; all had gliomas with oligodendroglial differentiation. All responders, eligible or ineligible, were stable or improved neurologically, but nine of 22 (41%) experienced a decline in Eastern Cooperative Oncology Group (ECOG) performance status of one grade while on PCV. Adverse events on treatment included a death from Pneumocystis pneumonia, a severe reversible encephalopathy due to procarbazine, an intratumoral hemorrhage, and a subdural hematoma. All other acute toxicities were anticipated and manageable. Conclusion: Anaplastic oligodendrogliomas are chemosensitive brain cancers. Patients with these tumors respond predictably, durably, and often completely to PCV, and many tolerate a dose-escalated formulation. Cooperative group and randomized trials will be necessary to explore fully the role of chemotherapy in the treatment of aggressive oligodendrogliomas.

Original languageEnglish (US)
Pages (from-to)2013-2021
Number of pages9
JournalJournal of Clinical Oncology
Volume12
Issue number10
DOIs
StatePublished - Oct 1994

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Cairncross, G., Macdonald, D., Ludwin, S., Lee, D., Cascino, T., Buckner, J., Fulton, D., Dropcho, E., Stewart, D., Schold, C., Wainman, N., & Eisenhauer, E. (1994). Chemotherapy for anaplastic oligodendroglioma. Journal of Clinical Oncology, 12(10), 2013-2021. https://doi.org/10.1200/JCO.1994.12.10.2013