FOTEMUSTINE IN RECURRENT SUPRATENTORIAL MALIGNANT GLIOMAS

Thirty-four adults with recurrent cerebral glioblastoma, including gli oblastoma multiforme (10), anaplastic astrocytoma (7), transformed low grade astrocytoma (7), persistent low grade astrocytoma (5) and recur rent radiological low grade astrocytoma without histological data at r elapse (5), were treated with fotemustine 100 mg/m(2) intravenously ev ery week for 3 consecutive weeks followed by a 5-week rest period. Mai ntenance treatment consisted of one infusion every 3 weeks. Twenty-fou r partial responses and stabilizations with a median progression-free survival of 56 weeks were observed in 70% of cases. Ten progressions ( 30%) were observed. Median overall survival from the start of treatmen t was 40 weeks, with a survival rate of 24% at 12 months and 16% at 18 months. Moreover, 3 patients had a prolonged survival, beyond 100 wee ks. The partial response or stabilization achieved by fotemustine was highly predictive of median survival duration: 40 weeks versus 24 week s in case of progression (p = 0.008). Myelosuppression was the most fr equent toxicity (17%) and was mild for all patients except one case of lethal myelodysplasia. Fotemustine is a safe chemotherapy for outpati ent management. It delays tumor progression for 2/3 of patients with r ecurrent malignant gliomas. In the absence of randomized studies, it i s not possible to compare fotemustine with older nitrosoureas. However , the evaluation of response by computed tomographic or by magnetic re sonance imaging, which have been used with new nitrosoureas such as fo temustine, provides a more reliable objective result than the analysis of clinical neurological improvement used for the evaluation of respo nse with older nitrosoureas. Therefore, we can conclude that results a re equivalent for the various nitrosoureas, but the median duration of response is often more prolonged with new nitrosoureas such as fotemu stine. Moreover, taking into consideration that fotemustine is a safe chemotherapy for outpatient management, it appears to be a good treatm ent of recurrent malignant brain tumors with an encouraging rate of ob jective responses and stabilizations (70%).