Einfluss der Adjutanten Chemotherapie mit Temozolomid auf die Zeit bis zum Tumorrezidiv bei Patienten mit Glioblastom
Adjuvant chemotherapy with Temozolomide for patients with glioblastoma and its impact on progression free survival
by Josefin Grabert
Date of Examination:2014-05-20
Date of issue:2014-05-06
Advisor:PD Dr. Florian Stockhammer
Referee:PD Dr. Florian Stockhammer
Referee:PD Dr. Tobias Pukrop
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Abstract
English
Background: The current standard for newly diagnosed glioblastoma consists of surgical resection followed by combined chemotherapy and radiotherapy as well as adjuvant chemotherapy with temozolomide for 6 cycles. Many centres continue temozolomide after 6 cycles. This retrospective study compares adjuvant temozolomide for 6 cycles with continued temozolomide in terms of progression free and overall survival. Methods: Patients were eligible, if they underwent surgery as well as radiotherapy (2Gy per day for 5 days a week, up to 60Gy) combined with daily temozolomide (75mg per m2/BSA), completed 6 cycles of temozolomide (150-200mg m2/BSA, 5 of 28 days) and had no signs of progressive disease on MRI. Respectively, patients who continued temozolomide were eligble if they completed 7 cycles temozolomide and showed no signs of progressive disease. Results: A total of 51 patients were included. 12 patients received 6 cycles of temozolomide (control group). 39 patients continued temozolomide (7 – 47 cycles, median 15,3 cycles). Progression free survival was 3,6 months for the control group, compared to 8,8 months for the group of continued therapy (p=0,009, logrank test). Overall survival was 13,9 months for the control group, compared to 20,3 months (p=0,04, logrank test). Discussion: Continuing temozolomide in this study shows a significant benefit for progression free and overall survival. Feasibility of long term temozolomide has been proved before, and stopping after 6 cycles seems arbitrary, but continuing would be an off-label use. Also, patient numbers in this study are limited, so further investigations should be performed. Conclusion: Continuing adjuvant temozolomide after 6 cycles in patients with newly diagnosed glioblastoma shows a significant benefit in progression free and overall survival. Due to small patient numbers and continuing temozolomide being an off-label use, further investigations should be performed.
Keywords: glioblastoma; continued adjuvant therapy; temozolomide
Schlagwörter: Glioblastom; Temozolomid; prolongierte adjuvante Therapie