RECURRENT CHIASMATIC-HYPOTHALAMIC GLIOMA TREATED WITH ORAL ETOPOSIDE

Purpose: Chiasmatic-hypothalamic gliomas are not amenable to surgical resection and therefore are treated with either radiotherapy or chemot herapy. Here we report the use of etoposide (VP-16) administered on a chronic oral schedule as a novel chemotherapeutic approach. Patients a nd Methods: Fourteen patients, aged 2 to 15 years, were treated with V P-16 after clinical and neuroradiographic tumor progression. Thirteen patients had received prior radiotherapy, and 12 received prior nitros ourea-based chemotherapy. VP-16 was administered orally, each cycle co nsisting of 50 mg/m(2)/d on days 1 through 21 and 36 through 57. Clini cal and neuroradiographic evaluations were performed during days 58 th rough 72 before initiation of each cycle of therapy. Complete blood co unts were performed weekly. Results: Treatment-related complications i ncluded the following: partial alopecia (seven patients); diarrhea (si x); weight loss (five); neutropenia (four); and thrombocytopenia (four ). Three patients required transfusion (three RBC; two platelet), and one patient required antibiotic treatment of neutropenic fever. There were no treatment-related deaths. Fourteen patients were assessable, f ive of whom demonstrated a radiographic response (one complete and fou r partial); and three patients demonstrated stable disease, with a med ian duration of response of 8 months. Conclusion: Chronic oral VP-16 i s well tolerated, produces modest toxicity, and has apparent activity in this small cohort of patients with recurrent chiasmatic-hypothalami c gliomas. (C) 1995 by American society of Clinical Oncology.