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Phase II Evaluation of Temozolomide and 13-cis-Retinoic Acid for the Treatment of Recurrent and Progressive Malignant Glioma: A North American Brain Tumor Consortium Study

Kurt A. Jaeckle, Kenneth R. Hess, W.K. Alfred Yung, Harry Greenberg, Howard Fine, David Schiff, Ian F. Pollack, John Kuhn, Karen Fink, Minesh Mehta, Timothy Cloughesy, M. Kelly Nicholas, Susan Chang, Michael Prados

From the University of Texas M.D. Anderson Cancer Center, Houston; University of Texas Health Science Center, San Antonio; and University of Texas Southwestern Medical Center, Dallas, TX; University of Michigan, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh and Children’s Hospital of Pittsburgh, Pittsburgh, PA; University of Wisconsin, Madison, WI; University of California at Los Angeles, Los Angeles; University of California at San Francisco, San Francisco, CA; University of Chicago, Chicago, IL.

Address reprint requests to Kurt A. Jaeckle, MD, Department of Oncology and Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Blvd, Jacksonville, FL 32224; email: jaeckle.kurt{at}mayo.edu.

Purpose: Temozolomide (TMZ) and 13-cis-retinoic acid (cRA) have shown activity in prior single-agent trials of recurrent malignant gliomas (MG). This phase II trial evaluated efficacy and toxicity of combination temozolomide and cRA treatment in recurrent MG.

Patients and Methods: Adults with recurrent supratentorial MG for whom surgery, radiation, and/or chemotherapy failed were eligible. Treatment included oral TMZ 150 or 200 mg/m²/d, days 1 through 5, and cRA 100 mg/m²/d, days 1 to 21, every 28 days. Primary end point was progression-free survival at 6 months (PFS 6); secondary end points included response, survival, and PFS12.

Results: Eighty-eight eligible patients (glioblastoma multiforme [n = 40]; anaplastic gliomas [n = 48; astrocytoma, 28; oligodendroglioma, 14; mixed glioma, six]) received treatment. PFS 6 was 43% (95% confidence interval [CI], 33% to 54%) and PFS12 was 16% (95% CI, 10% to 26%). Median overall PFS was 19 weeks (95% CI, 16 to 27 weeks), and median overall survival (OS) was 47 weeks (95% CI, 36 to 58 weeks). OS was 46% (95% CI, 36% to 57%) at 52 weeks and 21% (95% CI, 13% to 31%) at 104 weeks. Of 84 assessable patients, there were two (3%) complete responses and eight (12%) partial responses (complete plus partial response, 15%). Among 499 treatment cycles, the most common grade 3/4 events included granulocytopenia (1.8%), thrombocytopenia (1.4%), and hypertriglyceridemia (1.2%).

Conclusion: TMZ and cRA were active, exceeding our 20% thresholds for PFS 6 success, assuming 20% improvement over our previously reported database (glioblastoma multiforme: expected, 30%; observed, 32%; anaplastic glioma: expected, 40%; observed, 50%).

This research protocol was supported grants CA62399, CA62422, CA62412, CA16672, CA62455, CA62426, UO1CA62407-08, UO1CA62405, UO1CA62399, UO1CA62421, MO1-RR00079, MO1-RR00633, MO1-RR00056, MO1-RR0865, MO1-RR00042, and MO1-RR03186 from the National Institutes of Health, Bethesda, MD.

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