SALVAGE CHEMOTHERAPY WITH PACLITAXEL FOR RECURRENT PRIMARY BRAIN-TUMORS

Purpose: To assess the safety and efficacy of Taxol (paclitaxel; Brist ol-Myers Squibb Co, princeton, NJ) given at a dose of 175 mg/m(2) ever y 3 weeks as a 3- to 4-hour outpatient infusion to patients with recur rent malignant primary brain tumors who had received prior radiotherap y and at least one chemotherapy regimen containing nitrosoureas and wh o were no longer responding to therapy. Patients and Methods: Twenty p atients (12 men and eight women), ages 19 to 69 years (median, 35), wi th recurrent primary brain tumors were treated according to a phase II protocol with intravenous Taxol. Tumor histologies included the follo wing: anaplastic astrocytoma (n = 8), glioblastoma multiforme (n = 8), and anaplastic oligodendroglioma (n = 4). All patients had been previ ously treated with subtotal resection, limited-field radiotherapy (med ian dose, 60 Gy; range, 54 to 78 Gy), and nitrosourea-based chemothera py. Taxol was administered intravenously at a dose of 175 mg/m(2)/d ev ery 3 weeks with neurologic and neuroradiographic evaluation every 8 t o 9 weeks. Complete blood cell counts were performed weekly. Results: A median of six cycles of Taxol (range, two to 12) were administered t o 20 assessable patients. Toxicities included partial alopecia (n = 10 ), thrombocytopenia (n = 4), rate of Taxol administration-dependent br adycardia (n = 3), and nondisabling peripheral neuropathy (n = 1). No patient developed neutropenic fever or sepsis or required cytokine sup port. Two patients required blood-product support (platelet transfusio ns in both). Four patients (20%) demonstrated a partial response (PR) and seven (35%) had stable disease (SD) for a total response plus SD r ate of 55%. The median time to tumor progression was 6 months (range, 2 to 20). Conclusion: Taxol demonstrated modest efficacy with minimal toxicity in this heavily pretreated cohort of young patients with recu rrent primary brain tumors. (C) 1995 by American Society of Clinical O ncology.