Treosulfan chemotherapy for recurrent malignant glioma

Treosulfan is a bifunctional alkylating prodrug with activity against vario us solid tumors. To improve the outcome for patients with recurrent maligna nt glioma, we assessed the efficacy of intravenous treosulfan (6-10 g/m(2) 4-weekly) as salvage therapy for patients with recurrent or progressive gli oblastoma (GB, n = 14) or anaplastic astrocytoma (AA, n = 2). All patients had prior involved-field radiotherapy and adjuvant nitrosourea-based chemot herapy. A total of 56 cycles were administered. Tumor responses were assess ed radiologically and clinically prior to each cycle. All patients were ass essable for toxicity, response and survival. There were no complete or part ial responses (CR, PR). Two patients progressed after the first cycle, 14 p atients had initially stable disease (SD). Median progression-free survival was 3.25 months for the GB patients. Five patients were progression-free a t 6 months (30%), including the 2 AA patients. The 2 AA patients are stable at 22 months. Myelosuppression was the dose-limiting toxicity in this coho rt of nitrosourea-pretreated patients. Treosulfan has modest activity in pa tients with recurrent malignant glioma. Further evaluation of treosulfan in chemonaive malignant glioma patients is warranted.