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Journal of Neuro-Oncology

, Volume 100, Issue 2, pp 241–247 | Cite as

Phase I/II dose escalation trial of concurrent temozolomide and whole brain radiation therapy for multiple brain metastasis

  • Tom Mikkelsen
  • Joe Anderson
  • Thomas J. Doyle
  • David Croteau
  • Rita Avedissian
  • Sam Ryu
  • Lonni Schultz
Clinical Study - Patient Study

Abstract

This study sought to establish the recommended phase II dose and efficacy of temozolomide (TMZ) with concurrent radiotherapy in patients with brain metastases. Patients were stratified by prior systemic therapy (≤1 vs. ≥2) and enrolled in cohorts of escalating doses of daily TMZ for 14 days (group A: 75, 95, 115, 135, or 150 mg/m2, group B: 75, 90, 105, 120, or 135 mg/m2). Endpoints included safety and clinical activity. For group A (≤1 prior chemotherapy) no dose limiting toxicity was seen at 75 and 95 mg/m2. Five of eight patients experienced dose limiting toxicities at 115 mg/m2, thus the recommended phase II dose was 95 mg/m2. Arm B (≥2 prior chemotherapy regimens) was closed due to poor enrollment. In the phase II portion, 17 patients in group A were treated. There were 0 patients with complete radiographic response, three with a partial response, ten remained stable, and four demonstrated early progression. The 3 and 6 month progression-free survival (PFS) rates were 41 and 18% with a median PFS time of 2.4 months. Overall survival at 3 and 6 months was 53 and 41%, respectively, with a median survival time of 4.1 months. The maximum tolerated dose of daily TMZ with concurrent WBRT was 95 mg/m2. Despite dose escalation, outcomes did not appear to be improved in the sample treated.

Keywords

Temozolomide Whole brain radiation Metastatic carcinoma Brain 

Notes

Acknowledgments

Other support was generously provided from the Eugene and Marcia Applebaum Laboratory of the Hermelin Brain Tumor Center.

Conflicts of interest

This study was partially supported by Schering Plough. TM acknowledges support from Schering Plough for research support and activities on Speaker’s Bureau and Advisory Boards.

References

  1. 1.
    Posner JB (1995) Neurologic complications of cancer. F.A. Davis, PhiladelphiaGoogle Scholar
  2. 2.
    Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996CrossRefPubMedGoogle Scholar
  3. 3.
    Wurm R, Roeschel L, Scheffler D (2000) Phase I–II study with continuous dose-escalated 21 day schedule temozolomide in recurrent high-grade glioma. Proc Am Soc Clin Oncol 19:164aGoogle Scholar
  4. 4.
    Antonadou D, Paraskevaidis M, Sarris G et al (2002) Phase II randomized trial of temozolomide and concurrent radiotherapy in patients with brain metastases. J Clin Oncol 20:3644–3650CrossRefPubMedGoogle Scholar
  5. 5.
    Guerrieri M, Wong K, Ryan G, Millward M, Quong G, Ball DL (2004) A randomised phase III study of palliative radiation with concomitant carboplatin for brain metastases from non-small cell carcinoma of the lung. Lung Cancer 46:107–111CrossRefPubMedGoogle Scholar
  6. 6.
    Ushio Y, Arita N, Hayakawa T et al (1991) Chemotherapy of brain metastases from lung carcinoma: a controlled randomized study. Neurosurgery 28:201–205CrossRefPubMedGoogle Scholar
  7. 7.
    Verger E, Gil M, Yaya R et al (2005) Temozolomide and concomitant whole brain radiotherapy in patients with brain metastases: a phase II randomized trial. Int J Radiat Oncol Biol Phys 61:185–191PubMedGoogle Scholar
  8. 8.
    Kim DY, Lee KW, Yun T et al (2005) Efficacy of platinum-based chemotherapy after cranial radiation in patients with brain metastasis from non-small cell lung cancer. Oncol Rep 14:207–211PubMedGoogle Scholar
  9. 9.
    Kouvaris JR, Miliadou A, Kouloulias VE et al (2007) Phase II study of temozolomide and concomitant whole-brain radiotherapy in patients with brain metastases from solid tumors. Onkologie 30:361–366CrossRefPubMedGoogle Scholar
  10. 10.
    Weller M (2007) Radiochemotherapy for brain metastasis: how to define a role for temozolomide. Onkologie 30:350–351CrossRefPubMedGoogle Scholar
  11. 11.
    Addeo R, Caraglia M, Faiola V et al (2007) Concomitant treatment of brain metastasis with whole brain radiotherapy (WBRT), temozolomide (TMZ) is active, improves quality of life. BMC Cancer 7:18CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Tom Mikkelsen
    • 1
    • 2
    • 3
  • Joe Anderson
    • 4
  • Thomas J. Doyle
    • 4
  • David Croteau
    • 5
  • Rita Avedissian
    • 1
  • Sam Ryu
    • 6
  • Lonni Schultz
    • 2
    • 3
    • 7
  1. 1.Hermelin Brain Tumor CenterHenry Ford Health SystemDetroitUSA
  2. 2.Departments of NeurologyHenry Ford Health SystemDetroitUSA
  3. 3.Departments of NeurosurgeryHenry Ford Health SystemDetroitUSA
  4. 4.Department of Medical OncologyHenry Ford Health SystemDetroitUSA
  5. 5.Departments of NeuroscienceUniversity of CaliforniaSan DiegoUSA
  6. 6.Department of Radiation OncologyHenry Ford Health SystemDetroitUSA
  7. 7.Department of Biostatistics and Research EpidemiologyHenry Ford Health SystemDetroitUSA

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