Phase II trial of nitrogen mustard, vincristine, and procarbazine in patients with recurrent glioma: North central cancer treatment group results

Evanthia Galanis, Jan C. Buckner, Patrick A. Burch, Paul L. Schaefer, Robert P. Dinapoli, Paul J. Novotny, B. W. Scheithauer, Kendrith M. Rowland, Allen M. Vukov, James A. Mailliard, Roscoe F. Morton

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Abstract

Purpose: Previous investigators have reported responses in 52% of patients treated with mechlorethamine (nitrogen mustard), vincristine, and procarbazine (MOP) for recurrent glioma. To confirm these promising results, we conducted a phase II prospective study. Patients and Methods: Sixty-three patients with histologic confirmation of recurrent glioma were treated with the MOP regimen. Patients with or without prior chemotherapy received nitrogen mustard 3 mg/m2 or 6 mg/m2, respectively, intravenously on days 1 and 8 plus vincristine 2 mg/m2 intravenously on days 1 and 8, and procarbazine 100 mg/m2 orally on days 1 to 14. Cycles were repeated every 28 days. Results: Of 61 patients assessable for response, eight responded (13%), with one complete response (CR). Responses were as follows: low-grade gliomas, 19%; anaplastic astrocytomas, 11%; anaplastic oligodendrogliomas or oligoastrocytomas, 25%; and glioblastomas, 4.3%. The most common toxicity was myelosuppression with leukocyte nadirs less than 1,000/μL in 23% and platelet nadirs less than 25,000/μL in 13% of patients. Two patients died of infection in the setting of neutropenia. Nonhematologic toxicity included neurosensory changes in 21% of patients (severe in 3%) and severe dermatologic reactions in 8%. In multivariate analysis, Eastern Cooperative Oncology group (ECOG) performance status (PS) was the best predictor for response to chemotherapy (P = .01) and time to progression (P = .008), while PS and grade were the most important predictors of survival (P = .002 and .05, respectively). Conclusion: This study did not confirm the high response rate previously reported in recurrent gliomas. Patients with recurrent anaplastic oligodendrogliomas or oligoastrocytomas and recurrent low-grade gliomas had the highest response rates (25% and 19%, respectively). In multivariate analysis, ECOG PS was the best predictor of response, while PS and tumor grade were the most important predictors of survival.

Original languageEnglish (US)
Pages (from-to)2953-2958
Number of pages6
JournalJournal of Clinical Oncology
Volume16
Issue number9
DOIs
StatePublished - Sep 1998

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Galanis, E., Buckner, J. C., Burch, P. A., Schaefer, P. L., Dinapoli, R. P., Novotny, P. J., Scheithauer, B. W., Rowland, K. M., Vukov, A. M., Mailliard, J. A., & Morton, R. F. (1998). Phase II trial of nitrogen mustard, vincristine, and procarbazine in patients with recurrent glioma: North central cancer treatment group results. Journal of Clinical Oncology, 16(9), 2953-2958. https://doi.org/10.1200/JCO.1998.16.9.2953