This CE is published through an unrestricted educational grant from Bristol-Myers Squibb

Abstract

Credit

This lesson is good for 0.2 CE units, with a passing grade of 70%.

Goal

The goal of this program is to inform the participant about common types of malignant gliomas and to discuss new treatment modalities.

Objectives

At the completion of this program the participant will be able to:

Identify the standard types of treatment for primary brain tumors

Explain the pharmacology of temozolomide and irinotecan

List the most common adverse effects associated with temozolomide and irinotecan

Determine appropriate monitoring and provide dosing adjustments

Keywords

anaplastic astrocytoma chemotherapy glioblastoma multiforme irinotecan temozolomide

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References

Yung

W.K.

, Prados

M.D.

, Yaya-Tur

Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. J Clin Oncol. 1999; 17: 2762–71.

Collins

V P.

Gliomas. Cancer Surveys. 1998; 32: 37–71.

Avgeropoulos

N.G.

, Batchelor

T.T.

New treatment strategies for malignant gliomas. Oncologist. 1999; 4: 209–24.

Burton

, Prados

New chemotherapy options for the treatment of malignant gliomas. Curr Opin Oncol. 1999; 11: 157–61.

Wong

E.T.

, Hess

K.R.

, Gleason

M.J.

Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol. 1999; 17: 2572–8.

Fine

H.A.

, Dear

K.B.

, Loeffler

J.S.

Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer. 1993; 71: 2585–97.

Levin

V.A.

, Silver

, Hannigan

Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiol Oncol Biol Phys. 1990; 18: 321–4.

Mastronardi

, Puzzilli

, Couldwell

W.T.

Tamoxifen and carboplatin combinational treatment of high-grade gliomas: Results of a clinical trial on newly diagnosed patients. J Neurooncol. 1998; 38: 59–68.

Green

S.B.

, Byar

D.P.

, Walker

M.D.

Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Reports. 1983; 67: 121–32.

10.

Shapiro

W.R.

, Green

S.B.

, Burger

P.C.

Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg. 1989; 71: 1–9.

11.

Shapiro

W.R.

, Green

S.B.

, Burger

P.C.

A randomized comparison of intra-arterial versus intravenous BCNU, with or without intravenous 5-fluorouracil, for newly diagnosed patients with malignant glioma. J Neurosurg. 1992; 76: 772–81.

12.

Rodriguez

L.A.

, Levin

V.A.

: Does chemotherapy benefit the patient with a central nervous system glioma? Oncology. 1987; 1: 29–36.

13.

Brandes

A.A.

, Fiorentino

The role of chemotherapy in recurrent malignant gliomas; an overview. Cancer Invest. 1996; 14: 547–55.

14.

Prados

M.D.

, Scott

, Curran

W.J.

Procarbazine, lomustine, and vincristine (PCV) chemotherapy for anaplastic astrocytoma: A retrospective review of radiation therapy oncology group protocols comparing survival with carmustine or PCV adjuvant chemotherapy. J Clin Oncol. 1999; 17: 3389–95.

15.

Newton

H.B.

, Turowski

R.C.

, Stroup

T.J.

Clinical presentation, diagnosis, and pharmacotherapy of patients with primary brain tumors. Ann Pharmacother. 1999; 33: 816–32.

16.

Temodar package insert. Kenilworth, NJ: Schering-Plough; August 1999.

17.

Bleehan

, Newlands

E.S.

, Lee

S.M.

Cancer research campaign phase II trial of temozolomide in metastatic melanoma. J Clin Oncol. 1995; 13: 910–13.

18.

Dolan

M.E.

, McRae

B.L.

, Ferries Love

O6-alkylguanine-DNA alkyltransferase in cutaneous T-cell lymphoma: Implications for treatment with alkylating agents. Clin Cancer Res 1999; 5: 2059–64.

19.

Newlands

E.S.

, O'Reilly

S.M.

, Glaser

M.G.

The Charing Cross Hospital experience with temozolomide in patients with gliomas. Eur J Cancer. 1996; 32(A) 13: 2236–41.

20.

Woll

P.J.

, Crowther

, Johnson

P.W.

Phase II trial of temozolomide in low-grade non-Hodgkin's lymphoma. Br J Cancer. 1995; 72: 183–4.

21.

Chan

A.T.

, Leung

, Kwan

W.H.

Phase II study of Temodal in the treatment of patients with advanced nasopharyngeal carcinoma. Cancer Chemother Pharmacol. 1998; 42: 247–9.

22.

Moore

M.J.

, Feld

, Hedley

A phase II study of temozolomide in advanced untreated pancreatic cancer. Invest New Drugs. 1998; 16: 77–9.

23.

Newlands

E.S.

, Stevens

M.F.

, Wedge

S.R.

Temozolomide: A review of its discovery, chemical properties, pre-clinical development and clinical trials. Cancer Treatment Reviews. 1997; 23: 35–61.

24.

Plowman

, Waud

W.R.

, Koutsoukos

A.D.

Preclinical antitumor activity of temozolomide in mice: Efficacy against human brain tumor zenografts and syngergsim with 1,3-bis(2-chloroethyl)-1-nitrosourea. Cancer Res. 1994; 54: 3793.

25.

Teicher

B.A.

Antitumor alkylating agents. In: DeVita

V.T.

, Hellman

, Rosenberg

S.A.

, eds. Cancer, Principles and Practice of Oncology. Philadelphia, PA: Lippincott; 1997, 405–15.

26.

Estlin

E.J.

, Lashford

, Ablett

Phase I study of temozolomide in pediatric patients with advanced cancer. Br J Cancer. 1998; 78: 652–61.

27.

Bower

, Newlands

E.S.

, Bleehen

N.M.

Multicenter CRC phase II trial of temozolomide in recurrent or progressive high-grade glioma. Cancer Chemother Pharmacol. 1997; 40: 484–8.

28.

Data on file. Schering Plough Corporation, August 1999.

29.

Brock

C.S.

, Newlands

E.S.

, Wedge

S.R.

Phase I trial of temozolomide using an extended continuous oral schedule. Cancer Res. 1998; 58: 4363–7.

30.

Levin

V.A.

, Yung

, Prados

Temodal at first relapse in anaplastic astrocytoma patients. J Neurooncol. 1997; 35(suppl 1): 185a.

31.

Friedman

H.S.

, McLendon

R.E.

, Kerby

DNA mismatch repair and o6-alkylguanine-DNA alklytransferase analysis and response to temodal in newly diagnosed malignant glioma. J Clin Oncol. 1998; 16: 3851–7.

32.

Britten

C.D.

, Rowinsky

E.K.

, Baker

S.D.

A phase I and pharmacokinetic study of temozolomide and cisplatin in patients with advanced solid malignancies. Clin Cancer Res. 1999; 5: 1629–37.

33.

Newlands

E.S.

, Blackledge

G.R.

, Slack

J.A.

Phase I trial of temozolomide. Br J Cancer. 1992; 65: 287–91.

34.

Nicholson

H.S.

, Krailo

, Ames

M.M.

Phase I study of temozolomide in children and adolescents with recurrent solid tumors: A report from the children's cancer group. J Clin Oncol. 1998; 16: 3037–43.

35.

Rivory

L P.

Irinotecan (CPT-11): A brief interview. Clin Exp Pharmacol Physiol. 1996; 23: 1000–4.

36.

Cersosimo

R.J.

Irinotecan: A new anti-neoplastic agent for the management of colorectal cancer. Ann Pharmacother. 1998; 32: 1324–33.

37.

Chabot

G.G.

Clinical pharmacokinetics of irinotecan. Clin Pharmacokinet. 1997; 33: 245–59.

38.

Camptosar (Irinotecan) product information. Kalamazoo, MI: Pharmacia & Upjohn; 1999.

39.

Friedman

H.S.

, Petros

W.P.

, Friedman

A.H.

Irinotecan therapy in adults with recurrent or progressive malignant glioma. J Clin Oncol. 1999; 17: 1516–25.

40.

Berg

Irinotecan hydrochloride: Drug profile and nursing implications of a topoisomerase I inhibitor in patients with advanced colorectal cancer. Oncol Nurs Forum. 1998; 25: 53.

41.

Van Cutsem

, Blijham

G.H.

Irinotecan versus infusional 5-fluorouracil: A phase III study in metastatic colorectal cancer following failure on first-line 5-fluorouracil. Semin Oncol. 1999; 26: 13–20.

42.

Beckwith

M.C.

, Tyler

L.S.

, eds. The Chemotherapy Manual. 3nd ed. Salt Lake City, UT: University of Utah Hospitals and Clinics; 2000.