Open Access

Non‑conventional fotemustine schedule as second‑line treatment in recurrent malignant gliomas: Survival across disease and treatment subgroup analysis and review of the literature

  • Authors:
    • Arsela Prelaj
    • Sara Elena Rebuzzi
    • Massimiliano Grassi
    • Maurizio Salvati
    • Alessandro D'Elia
    • Francesca Buttarelli
    • Carla Ferrara
    • Silverio Tomao
    • Vincenzo Bianco
  • View Affiliations

  • Published online on: October 16, 2018     https://doi.org/10.3892/mco.2018.1746
  • Pages: 58-66
  • Copyright: © Prelaj et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Fotemustine (FTM) is a treatment option in recurrent malignant gliomas (MGs) after first‑line Stupp treatment. The efficacy and the safety of fractionated FTM schedule proposed by Addeo et al was analysed in the present study in recurrent MGs patients. A retrospective analysis on 40 recurrent MGs patients and second‑line fractionated FTM chemotherapy was performed. Response evaluation was assessed using RANO criteria and safety was assessed using CTCAE v.4.03. Subgroup analyses based on MGMT methylation, resurgery and reirradiation were performed. A review of the literature was also performed. The results revealed 5 partial responses (13%) and 19 stable diseases (47%) with a disease‑control rate of 60%. Median progression‑free survival (PFS) was 4 months, with a PFS of 33% at 6 months and 13% at 1 year. The median overall survival (OS) was 9 months and OS at 6 months was of 55% and at 1 year of 30%. Methylated patients experienced longer mPFS (6 vs. 3 months; p=0.004) and mOS (10 vs. 4 months; p<0.0001) compared with unmethylated patients. Patients treated with reirradiation experienced longer mPFS (5 vs. 3.5 months; p=0.48) and mOS (10 vs. 5 months; p=0.11). No survival benefit with resurgery was observed. Furthermore, the fractioned schedule was well tolerated, only 15% of patients developed severe myelotoxicities. Considering the present findings, fractionated FTM schedule is an efficient second‑line option for MGs associated with an acceptable myelotoxicity profile. Additionally, MGMT methylation is associated with improved survival outcomes. However, this study highlights the requirement for further prospective randomized studies on resurgery and reirradiation.
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January 2019
Volume 10 Issue 1

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APA
Prelaj, A., Rebuzzi, S.E., Grassi, M., Salvati, M., D'Elia, A., Buttarelli, F. ... Bianco, V. (2019). Non‑conventional fotemustine schedule as second‑line treatment in recurrent malignant gliomas: Survival across disease and treatment subgroup analysis and review of the literature. Molecular and Clinical Oncology, 10, 58-66. https://doi.org/10.3892/mco.2018.1746
MLA
Prelaj, A., Rebuzzi, S. E., Grassi, M., Salvati, M., D'Elia, A., Buttarelli, F., Ferrara, C., Tomao, S., Bianco, V."Non‑conventional fotemustine schedule as second‑line treatment in recurrent malignant gliomas: Survival across disease and treatment subgroup analysis and review of the literature". Molecular and Clinical Oncology 10.1 (2019): 58-66.
Chicago
Prelaj, A., Rebuzzi, S. E., Grassi, M., Salvati, M., D'Elia, A., Buttarelli, F., Ferrara, C., Tomao, S., Bianco, V."Non‑conventional fotemustine schedule as second‑line treatment in recurrent malignant gliomas: Survival across disease and treatment subgroup analysis and review of the literature". Molecular and Clinical Oncology 10, no. 1 (2019): 58-66. https://doi.org/10.3892/mco.2018.1746