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Salvage chemotherapy With CPT-11 for recurrent meningioma

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Summary

Background

A prospective Phase II study of irinotecan (CPT-11) in adult patients with recurrent surgery and radiotherapy-refractory WHO Grade I meningioma.

Methods

Sixteen patients (5 men; 11 women) ages 48–70 years (median 62.5), with recurrent meningioma were treated. All patients had previously been treated with surgery (complete in 4; partial in 9; biopsy in 3) and involved-field radiotherapy (median dose 54 Gy; 12 following first surgery and 4 following second surgery). Additionally, eight patients underwent re-operation (complete in 2; partial in 6) and eight patients were treated with salvage stereotactic radiosurgery. No patient was treated with prior chemotherapy. CPT-11 was administered intravenously every 3 weeks (350 mg/m2/day in patients on non-enzyme inducing anticonvulsants [NEIAED]; 600 mg/m2/day in patients on enzyme-inducing anticonvulsants [EIAED]) for 9 weeks (operationally defined as a single cycle). Neurological and neuroradiographic evaluation were performed every 10 weeks.

Results

All patients were evaluable. A median of two cycles of CPT-11 (range 1–4) was administered. CPT-11 related-toxicity (≥grade 3) included diarrhea (6 occurrences, 19% all cycles administered), granulocytopenia (6,␣19%), leukopenia (5, 16%), thrombocytopenia (3, 10%) and anemia (3, 10%). Four patients required transfusion (3 RBC and 1 platelet). One patient developed neutropenic fever without bacteriologic confirmation. No treatment-related deaths occurred. No patient demonstrated a neuroradiographic complete or partial response (PR), 13 patients (81%) demonstrated stable disease but disease progressed after 2 cycles of CPT-11, and 3 patients (19%) had progressive disease (PD) following a single cycle of CPT-11. Time to tumor progression ranged from 2.5 to 5.0 months (median 5.0 months). Survival ranged from 4 to months (median 7.5 months).

Conclusions

The primary objective was to estimate the 6-month progression-free survival (PFS) after study entry. As no patient demonstrated PFS at 6-months, the study was stopped prematurely as specified by study design. Using CPT-11 in this moderately toxic dose schedule failed to demonstrate efficacy in this cohort of adult patients with recurrent surgery and radiotherapy-refractory meningioma.

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Acknowledgement

Ms. Nadine Stanton for secretarial assistance.

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Authors and Affiliations

  1. Department of Interdisciplinary Oncology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Suite 2010, Tampa, Florida, 33612, USA

    Marc C. Chamberlain

  2. Department of Preventive Medicine, USC/Norris Cancer Center, Los Angels, California, USA

    Denice D. Tsao-Wei & Susan Groshen

Authors
  1. Marc C. Chamberlain
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  2. Denice D. Tsao-Wei
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  3. Susan Groshen
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Correspondence to Marc C. Chamberlain.

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Chamberlain, M.C., Tsao-Wei, D.D. & Groshen, S. Salvage chemotherapy With CPT-11 for recurrent meningioma. J Neurooncol 78, 271–276 (2006). https://doi.org/10.1007/s11060-005-9093-x

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  • DOI: https://doi.org/10.1007/s11060-005-9093-x

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