Carmustine (BCNU) plus Teniposide (VM26) in recurrent malignant glioma

Area of Science:

• Neuro-oncology
• Clinical pharmacology
• Cancer treatment

Background:

• Recurrent glioblastoma (GBM) lacks standard therapy post-radiotherapy and temozolomide.
• Nimustine and teniposide (VM26) combination showed promise, but nimustine became unavailable.
• Intravenous carmustine (BCNU) replaced nimustine, necessitating data on BCNU/VM26 efficacy and toxicity in recurrent GBM.

Purpose of the Study:

• To retrospectively evaluate the efficacy and toxicity of BCNU and VM26 combination therapy.
• To assess progression-free survival (PFS) and overall survival (OS) in recurrent GBM patients treated with BCNU/VM26.
• To determine the safety profile, including hematological and non-hematological toxicity, of this regimen.

Main Methods:

• Retrospective analysis of 15 recurrent GBM patients treated with BCNU (130-150 mg/m², day 1/42) and VM26 (45-60 mg/m², days 1-3/42).
• Evaluation of progression-free survival (PFS) and overall survival (OS).
• Assessment of treatment-related toxicity, including hematotoxicity and non-hematological adverse events (≥grade 3).

Main Results:

• Median PFS was 2 months and median OS was 4 months.
• Two patients (14%) experienced grade 3/4 hematotoxicity.
• No non-hematological toxicity of grade 3 or higher was observed.

Conclusions:

• The BCNU/VM26 combination demonstrated limited clinical benefit in patients with late-stage recurrent GBM.
• The observed survival outcomes do not support the use of this regimen in this patient population.
• Further research into alternative therapies for recurrent GBM is warranted.