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- Title
Phase II trial of temozolomide plus concurrent whole-brain radiation followed by TNV regimen as adjuvant therapy for patients with newly diagnosed primary CNS lymphoma.
- Authors
Yong Wang; Baoyan Liu; Dezhi Xu; Haitao Zhao; Yufang Zhu; Jun Xu; Rongjie Tao
- Abstract
Background: Primary central nervous system lymphoma (PCNSL) is an aggressive extranodal non-Hodgkin's lymphoma limited to the CNS. Treatment of PCNSL with high-dose methotrexate (HD-MTX)-based chemotherapy and whole-brain radiotherapy (WBRT) is associated with high rates of relapse and severe treatment-related neurotoxicity . Aim: To report our experience of treating newly diagnosed PCNSL with temozolomide, nedaplatin, and vincristine (TNV), as the replacement of HD-MTX, in combination with concurrent chemoradiotherapy . Materials and Methods: Newly diagnosed PCNSL patients were given concurrent temozolomide (75 mg/m², orally) daily during WBRT. Then, the TNV regimen was given after four weeks. The TNV regimen consisted of temozolomide (200 mg/m² orally: Days 1-5), nedaplatin (80 mg/m intravenous: Day 1), and vincristine (1.4 mg/m² intravenous: Day 1). Each cycle was of a duration of four weeks and a maximum of six cycles were applied. The primary end point was response to treatment obtained by magnetic resonance imaging (MRI). Secondary end points were progression-free survival (PFS) and fewer toxic effects. Results: The study subjects included 14 patients (median age: 53.5, median Karnofsky Performance Scale (KPS): 75). The median number of TNV cycles given was five. Response to treatment: Complete response in 12 (85.7%) patients, partial response in 2 (14.3%) patients, and none with progressive disease. The objective response rate was 100%, and median PFS was 21.4 months. Toxicity was relatively mild, which mainly included nausea in six and fatigue in five, grade 3-4 hematotoxicity in one, and abnormal liver functions in five patients. No neurotoxicity has been observed till date. Conclusion: The efficacy outcomes in this study are comparable to other reported HD-MTX-based regimens plus WBRT, with an added favorable toxicity profile. Prospective, randomized controlled trials are warranted to confirm such results.
- Subjects
ADJUVANT treatment of cancer; THERAPEUTICS; CENTRAL nervous system diseases; LYMPHOMA treatment; ALKYLATING agents; METHOTREXATE; NEUROTOXICOLOGY
- Publication
Neurology India, 2013, Vol 61, Issue 3, p260
- ISSN
0028-3886
- Publication type
Article
- DOI
10.4103/0028-3886.115065