Salvage chemotherapy for recurrent spinal cord ependymona

Area of Science:

• Neuro-oncology
• Medical Oncology
• Clinical Pharmacology

Background:

• Ependymomas are rare primary central nervous system (CNS) tumors, with spinal cord ependymomas (SCE) accounting for 30% of adult cases.
• Recurrent low-grade intramedullary SCE presents a significant treatment challenge, often after surgery and radiotherapy failure.

Purpose of the Study:

• To evaluate the toxicity and response of chronic oral etoposide in adult patients with recurrent low-grade intramedullary SCE.
• To assess the efficacy of oral etoposide in a challenging patient population with refractory spinal cord tumors.

Main Methods:

• A prospective Phase II study treated 10 patients with recurrent SCE using oral etoposide (50mg/m(2)/day for 21 days, followed by a 14-day break).
• Treatment involved weekly blood counts, monthly neurologic exams, and monthly chemistry panels. Spine MRIs were conducted every 8 weeks.

Main Results:

• Common toxicities included alopecia (90%), diarrhea (60%), and weight loss (50%). Grade 3-4 neutropenia, thrombocytopenia, and anemia occurred in 30%, 30%, and 20% of patients, respectively.
• Objective responses (partial response or stable disease) were observed in 70% of patients, with a median progression-free survival of 15 months and median overall survival of 17.5 months.

Conclusions:

• Chronic oral etoposide is generally well-tolerated with modest toxicity in patients with recurrent intramedullary SCE.
• The study suggests that oral etoposide has apparent activity and could be a viable treatment option for surgically and medically refractory spinal cord ependymomas.