Cisplatinum and BCNU chemotherapy in primary glioblastoma patients

Antonio Silvani, Paola Gaviani, Elena A. Lamperti, Marica Eoli, Chiara Falcone, Francesco DiMeco, Ida M. Milanesi, Alessandra Erbetta, Amerigo Boiardi, Laura Fariselli, Andrea Salmaggi

Research output: Contribution to journalArticle

Abstract

Background: The prognosis of patients with glioblastoma is very poor with a mean survival of 10-12 months. Currently available treatment options are multimodal, which include surgery, radiotherapy, and chemotherapy. However, these have been shown to improve survival only marginally in glioblastoma multiforme (GBM) patients. Methylated methylguanine methyltransferase (MGMT) promoter is correlated with improved progression-free and overall survival in patients treated with alkylating agents. Strategies to overcome MGMT-mediated chemoresistance are being actively investigated. Methods: A retrospective analysis on 160 adult patients (≥16 years) treated for histologically confirmed GBM between 2003 and 2005 at our Institution was performed. All patients were treated with conventional fractionated radiotherapy and a combined chemotherapy treatment with Cisplatin (CDDP) (100 mg/sqm on day 1) and carmustine (BCNU) (160 mg/sqm on day 2); the treatment was repeated every 6 weeks for five cycles. Toxicity, progression free survival and overall survival were assessed. Results: The median number of chemotherapy cycles delivered to each patient was 5 (range 3-6), with no patients discontinuing treatment because of refusal or toxicity. Dose reduction was required in 16 patients (10%), and all patients completed radiotherapy, whereas 5 patients discontinued chemotherapy before completing all planned cycles for disease progression. The primary toxicities were: neutropenia (grade 3-4: 23%), thrombocytopenia (grade 3-4: 18.5%), and nausea and vomiting (13%). Median progression-free survival times and 1-year progression free survival were 7.6 months (95% CI 6.6-8.5) and 17.3%, respectively. OS was 15.6 months (95% CI 14.1-17.1). Conclusions: Our results for PFS and overall survival are comparable with those obtained with temozolomide, but the toxicity occurring in our series was more frequent and persistent. The toxicity, and mainly the modalities of administration associated with cisplatin and BCNU combination, argues against future use in the treatment of patients with GBM.

Original languageEnglish (US)
Pages (from-to)57-62
Number of pages6
JournalJournal of Neuro-Oncology
Volume94
Issue number1
DOIs
StatePublished - 2009
Externally publishedYes

Fingerprint

Carmustine
Glioblastoma
Drug Therapy
Disease-Free Survival
Radiotherapy
Survival
temozolomide
Methyltransferases
Cisplatin
Treatment Refusal
Combined Modality Therapy
Alkylating Agents
Neutropenia
Nausea
Vomiting
Disease Progression
Therapeutics

Keywords

  • BCNU
  • Chemotherapy
  • Cisplatinum
  • Glioblastoma
  • Temozolomide

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neurology

Cite this

Silvani, A., Gaviani, P., Lamperti, E. A., Eoli, M., Falcone, C., DiMeco, F., ... Salmaggi, A. (2009). Cisplatinum and BCNU chemotherapy in primary glioblastoma patients. Journal of Neuro-Oncology, 94(1), 57-62. https://doi.org/10.1007/s11060-009-9800-0

Cisplatinum and BCNU chemotherapy in primary glioblastoma patients. / Silvani, Antonio; Gaviani, Paola; Lamperti, Elena A.; Eoli, Marica; Falcone, Chiara; DiMeco, Francesco; Milanesi, Ida M.; Erbetta, Alessandra; Boiardi, Amerigo; Fariselli, Laura; Salmaggi, Andrea.

In: Journal of Neuro-Oncology, Vol. 94, No. 1, 2009, p. 57-62.

Research output: Contribution to journalArticle

Silvani, A, Gaviani, P, Lamperti, EA, Eoli, M, Falcone, C, DiMeco, F, Milanesi, IM, Erbetta, A, Boiardi, A, Fariselli, L & Salmaggi, A 2009, 'Cisplatinum and BCNU chemotherapy in primary glioblastoma patients', Journal of Neuro-Oncology, vol. 94, no. 1, pp. 57-62. https://doi.org/10.1007/s11060-009-9800-0
Silvani A, Gaviani P, Lamperti EA, Eoli M, Falcone C, DiMeco F et al. Cisplatinum and BCNU chemotherapy in primary glioblastoma patients. Journal of Neuro-Oncology. 2009;94(1):57-62. https://doi.org/10.1007/s11060-009-9800-0
Silvani, Antonio ; Gaviani, Paola ; Lamperti, Elena A. ; Eoli, Marica ; Falcone, Chiara ; DiMeco, Francesco ; Milanesi, Ida M. ; Erbetta, Alessandra ; Boiardi, Amerigo ; Fariselli, Laura ; Salmaggi, Andrea. / Cisplatinum and BCNU chemotherapy in primary glioblastoma patients. In: Journal of Neuro-Oncology. 2009 ; Vol. 94, No. 1. pp. 57-62.
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AU - Gaviani, Paola

AU - Lamperti, Elena A.

AU - Eoli, Marica

AU - Falcone, Chiara

AU - DiMeco, Francesco

AU - Milanesi, Ida M.

AU - Erbetta, Alessandra

AU - Boiardi, Amerigo

AU - Fariselli, Laura

AU - Salmaggi, Andrea

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N2 - Background: The prognosis of patients with glioblastoma is very poor with a mean survival of 10-12 months. Currently available treatment options are multimodal, which include surgery, radiotherapy, and chemotherapy. However, these have been shown to improve survival only marginally in glioblastoma multiforme (GBM) patients. Methylated methylguanine methyltransferase (MGMT) promoter is correlated with improved progression-free and overall survival in patients treated with alkylating agents. Strategies to overcome MGMT-mediated chemoresistance are being actively investigated. Methods: A retrospective analysis on 160 adult patients (≥16 years) treated for histologically confirmed GBM between 2003 and 2005 at our Institution was performed. All patients were treated with conventional fractionated radiotherapy and a combined chemotherapy treatment with Cisplatin (CDDP) (100 mg/sqm on day 1) and carmustine (BCNU) (160 mg/sqm on day 2); the treatment was repeated every 6 weeks for five cycles. Toxicity, progression free survival and overall survival were assessed. Results: The median number of chemotherapy cycles delivered to each patient was 5 (range 3-6), with no patients discontinuing treatment because of refusal or toxicity. Dose reduction was required in 16 patients (10%), and all patients completed radiotherapy, whereas 5 patients discontinued chemotherapy before completing all planned cycles for disease progression. The primary toxicities were: neutropenia (grade 3-4: 23%), thrombocytopenia (grade 3-4: 18.5%), and nausea and vomiting (13%). Median progression-free survival times and 1-year progression free survival were 7.6 months (95% CI 6.6-8.5) and 17.3%, respectively. OS was 15.6 months (95% CI 14.1-17.1). Conclusions: Our results for PFS and overall survival are comparable with those obtained with temozolomide, but the toxicity occurring in our series was more frequent and persistent. The toxicity, and mainly the modalities of administration associated with cisplatin and BCNU combination, argues against future use in the treatment of patients with GBM.

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