Efficacy and Feasibility of Procarbazine, Ranimustine and Vincristine Chemotherapy, and the Role of Surgical Resection in Anaplastic Oligodendroglioma

Abstract

The safety, tolerance and preliminary efficacy of a chemotherapy regimen consisting of procarbazine (PCB), ranimustine (MCNU) and vincristine (VCR) were assessed for patients with newly diagnosed supratentorial anaplastic oligodendroglioma. Materials and Methods: Between October 1999 and September 2003, 5 patients were enrolled. The initial regimens were prescribed as adjuvant therapy in conjunction with radiotherapy following standard surgical treatment. All patients received a chemotherapy comprising ranimustine (100 mg/m²) intravenously on Day 1, procarbazine (60 mg/m²) on Days 8 to 21, and vincristine (1.4 mg/m², maximum total 2 mg) on Days 8 and 29. The cycles were repeated every 8 weeks until tumor progression was evident, or for a total of 6 cycles over a 1-year period. The primary end-points were safety and tolerability, while the secondary end-point was overall survival. Results: Five consecutive eligible patients were treated. Of the 4 evaluable patients, 3 partially responded to the treatment (PR), while 1 had a complete response (CR): all patients are still alive. However, 3 of the 5 patients showed relapse, with a time to tumor progression (TTP) of 50, 143 and 241 weeks, respectively. Two of these patients received combined treatment with carboplatin, etoposide and recombinant human mutant tumor necrosis factor-alpha at the first relapse. This regimen appeared to be safe and neither neurological toxicity, severe or life-threatening hematological toxicity, nor fatal toxicity (WHO Grade 4) were experienced. Conclusion: These results suggest that a chemotherapy regimen consisting of PCB, MCNU and VCR in this patient population seems to be safe and tolerable, and the response rate was high. Thus, wide resection with a risk of major neurological morbidity due to nearby functionally critical areas can be avoided. However, since the relapse rate was high, a second-line chemotherapy should be developed for anaplastic oligodendroglioma to improve the long-term control of the disease.