1. Phase II study of sunitinib malate in patients with recurrent high-grade glioma.
- Author
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Neyns B, Sadones J, Chaskis C, Dujardin M, Everaert H, Lv S, Duerinck J, Tynninen O, Nupponen N, Michotte A, and De Greve J
- Subjects
- Adult, Aged, Central Nervous System Neoplasms diagnosis, Central Nervous System Neoplasms pathology, Cerebrovascular Circulation, Disease Progression, Female, Glioma diagnosis, Glioma pathology, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Positron-Emission Tomography, Proto-Oncogene Proteins c-kit metabolism, Pyrrolidinones, Receptors, Platelet-Derived Growth Factor metabolism, Recurrence, Regional Blood Flow drug effects, Sunitinib, Vascular Endothelial Growth Factor Receptor-2 metabolism, Antineoplastic Agents therapeutic use, Central Nervous System Neoplasms drug therapy, Glioma drug therapy, Indoles therapeutic use, Pyrroles therapeutic use
- Abstract
Receptor tyrosine kinase signaling causes profound neo-angiogenesis in high-grade gliomas (HGG). The KIT, PDGFR-α, and VEGFR2 genes are frequently amplified and expressed in HGG and are molecular targets for therapeutic inhibition by the small-molecule kinase inhibitor sunitinib malate. Twenty-one patients with progressive HGG after prior radiotherapy and chemotherapy received a daily dose of 37.5 mg sunitinib until progression or unacceptable toxicity. Magnetic resonance imaging (MRI) and dynamic susceptibility contrast (DSC)-enhanced perfusion measurements were performed before and during therapy. Cerebral blood volume (CBV) and cerebral blood flow (CBF) lesion-to-normal-white matter ratios were measured to evaluate the antiangiogenic effects of sunitinib. The most frequent grade ≥3 adverse events were skin toxicity, neutropenia, thrombocytopenia, and lymphocytopenia. None of the patients achieved an objective response, whereas a decrease in CBV and CBF within the lesion compared with the normal brain was documented in four out of 14 (29%) patients evaluable for DSC-enhanced perfusion measurements. All patients experienced progression of their disease before or after eight weeks of therapy. Median time-to-progression and overall survival were 1.6 (95%CI 0.8-2.5) and 3.8 (95% CI 2.2-5.3) months, respectively. No correlation could be established between VEGFR2, PDGFR-α, and KIT gene copy numbers or protein expression and the effects of sunitinib. Single-agent sunitinib at 37.5 mg/day had insufficient activity to warrant further investigation of this monotherapy regimen in recurrent HGG.
- Published
- 2011
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