COMPARISON BETWEEN BCNU AND PROCARBAZINE CHEMOTHERAPY FOR TREATMENT OF GLIOMAS

We compared sequential single-agent BCNU and procarbazine (PCB) chemot herapy in 31 patients with gliomas [grade IV (10), grade III (15), gra de II (6)]. Patients had failed surgical biopsy+/- resection and radia tion therapy. All patients were treated initially with BCNU 150-300mg/ m2 by intra-arterial or intravenous route every 6 weeks. After CT evid ence of tumor progression, all patients received PCB 150 mg/m2/day for 28 days every 8 weeks. Patient responses to BCNU were CR (0), PR (7), SD (12), progression (12), and to PCB CR (2), PR (9), SD (6), and pro gression (14). Kaplan-Meier estimates of median time to failure for al l patients were shorter for BCNU, 5.0 months (range 1.5-20), than for PCB, 6.0 months (range 2-50+). There was a statistically significant d ifference (Mantel-Cox test, p = 0.02) in the distribution of time to d isease progression between the two drugs, especially for grade III tum ors (p = 0,02). The cumulative proportion of patients without disease progression at 6 months was 26% while on BCNU, compared to 48% while o n PCB; at 12 months the cumulative proportions were 3% for BCNU compar ed to 35% for PCB. Although there was no formal washout period between administration of the two drugs, no carryover effect was evident. The se data provide further evidence that PCB has significant activity aga inst malignant glioma and may, in fact, be more effective than BCNU.