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Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2000 Feb; Vol. 18 (4), pp. 708-15. - Publication Year :
- 2000
-
Abstract
- Purpose: Little progress has been made in the treatment of adult high-grade gliomas over the last two decades, thus necessitating a search for novel therapeutic strategies. Malignant gliomas are vascular or angiogenic tumors, which leads to the supposition that angiogenesis inhibition may represent a potentially promising strategy in the treatment of these tumors. We present the results of a phase II trial of thalidomide, a putative inhibitor of angiogenesis, in the treatment of adults with previously irradiated, recurrent high-grade gliomas.<br />Patients and Methods: Patients with a histologic diagnosis of anaplastic mixed glioma, anaplastic astrocytoma, or glioblastoma multiforme who had radiographic demonstration of tumor progression after standard external-beam radiotherapy with or without chemotherapy were eligible. Patients were initially treated with thalidomide 800 mg/d with increases in dose by 200 mg/d every 2 weeks until a final daily dose of 1,200 mg was achieved. Patients were evaluated every 8 weeks for response by both clinical and radiographic criteria.<br />Results: A total of 39 patients were accrued, with 36 patients being assessable for both toxicity and response. Thalidomide was well tolerated, with constipation and sedation being the major toxicities. One patient developed a grade 2 peripheral neuropathy after treatment with thalidomide for nearly a year. There were two objective radiographic partial responses (6%), two minor responses (6%), and 12 patients with stable disease (33%). Eight patients were alive more than 1 year after starting thalidomide, although almost all with tumor progression. Changes in serum levels of basic fibroblastic growth factor (bFGF) were correlated with time to tumor progression and overall survival.<br />Conclusion: Thalidomide is a generally well-tolerated drug that may have antitumor activity in a minority of patients with recurrent high-grade gliomas. Future studies will better define the usefulness of thalidomide in newly diagnosed patients with malignant gliomas and in combination with radiotherapy and chemotherapy. Additionally, studies will be needed to confirm the potential utility of changes in serum bFGF as a marker of antiangiogenic activity and/or glioma growth.
- Subjects :
- Adult
Aged
Angiogenesis Inhibitors administration & dosage
Angiogenesis Inhibitors adverse effects
Biomarkers, Tumor blood
Chemotherapy, Adjuvant
Combined Modality Therapy
Constipation chemically induced
Disease Progression
Female
Fibroblast Growth Factor 2 blood
Follow-Up Studies
Glioblastoma drug therapy
Glioblastoma radiotherapy
Glioma radiotherapy
Humans
Hypnotics and Sedatives adverse effects
Male
Middle Aged
Peripheral Nervous System Diseases chemically induced
Remission Induction
Supratentorial Neoplasms radiotherapy
Survival Rate
Thalidomide administration & dosage
Thalidomide adverse effects
Angiogenesis Inhibitors therapeutic use
Glioma drug therapy
Neoplasm Recurrence, Local drug therapy
Supratentorial Neoplasms drug therapy
Thalidomide therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0732-183X
- Volume :
- 18
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 10673511
- Full Text :
- https://doi.org/10.1200/JCO.2000.18.4.708