Authors: Florian Stockhammer Martin Misch Arend Koch Marcus Czabanka Michail Plotkin Cristiane Blechschmidt Jochen Tuettenberg Peter Vajkoczy
Publish Date: 2010/05/06
Volume: 100, Issue: 3, Pages: 407-415
Abstract
Even after gross tumor resection and combined radiochemotherapy glioblastomas recur within a few months Salvage therapy often consists of rechallenging with temozolomide in a doseintensified schedule Previously lowdose metronomic temozolomide in combination with cyclooxigenase 2 inhibitors has had a beneficial effect as firstline treatment for glioblastoma We report our experience with this procedure in recurrent glioblastomas after standard treatment From June 2007 to April 2009 28 patients with recurrent glioblastoma received continuous lowdose temozolomide of 10 mg/m2 twice daily and 200 mg celecoxib Before therapy the recurrent tumor was resected in 19 of 28 patients Microvessel density MVD was determined by immunohistochemistry in 19 patients and MGMT promoter methylation status using the pyrosequencing method was determined in 17 patients In 14/28 patients positron emission tomography with F18fluoroethylltyrosine FETPET was performed Tumor progression was defined by the Macdonald criteria on MRI every 8–12 weeks or by clinical deterioration The median time to progression was 42 months Progressionfree survival PFS after 6 months was 43 Except for a lymphopenia in one patient there was no grade 3 or 4 toxicity PFS did not correlate with MVD or MGMT status A high FET uptake correlated with tumor control after 6 months under therapy P = 0041 ttest Lowdose continuous temozolomide in combination with celecoxib seems to have activity in recurrent glioblastoma without relevant toxicity High FET uptake correlated with a better outcome under metronomic therapy
Keywords: