دورية أكاديمية
Thrombocytopenia limits the feasibility of salvage lomustine chemotherapy in recurrent glioblastoma: a secondary analysis of EORTC 26101.
| العنوان: | Thrombocytopenia limits the feasibility of salvage lomustine chemotherapy in recurrent glioblastoma: a secondary analysis of EORTC 26101. |
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| المؤلفون: | Le Rhun E; Departments of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland; Departments of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. Electronic address: emilie.lerhun@usz.ch., Oppong FB; EORTC Headquarters, Brussels, Belgium., van den Bent M; Erasmus MC Cancer Center, Rotterdam, the Netherlands., Wick W; Department of Neurology and Neurooncology Program at the National Center for Tumor Diseases, University Hospital Heidelberg and German Cancer Research Center, Heidelberg, Germany., Brandes AA; Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto Delle Scienze Neurologiche, Bologna, Italy., Taphoorn MJ; Leiden University Medical Center, Departments of Neurology, Leiden, And Haaglanden Medical Center, The Hague, the Netherlands., Platten M; Medical Faculty Mannheim, MCTN, Department of Neurology, Mannheim, Germany., Idbaih A; Sorbonne Université, Institut Du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France., Clement PM; Department of Oncology, KU Leuven, Leuven Cancer Institute-KU Leuven, Leuven, Belgium., Preusser M; Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria., Golfinopoulos V; EORTC Headquarters, Brussels, Belgium., Gorlia T; EORTC Headquarters, Brussels, Belgium., Weller M; Departments of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. |
| المصدر: | European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2023 Jan; Vol. 178, pp. 13-22. Date of Electronic Publication: 2022 Oct 20. |
| نوع المنشور: | Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Science Ltd Country of Publication: England NLM ID: 9005373 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0852 (Electronic) Linking ISSN: 09598049 NLM ISO Abbreviation: Eur J Cancer Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Oxford : Elsevier Science Ltd Original Publication: Oxford ; New York : Pergamon Press, c1990- |
| مواضيع طبية MeSH: | Brain Neoplasms*/therapy , Glioblastoma*/therapy , Thrombocytopenia*/chemically induced , Thrombocytopenia*/drug therapy, Humans ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Bevacizumab/adverse effects ; Feasibility Studies ; Lomustine/adverse effects ; Neoplasm Recurrence, Local/pathology ; Retrospective Studies |
| مستخلص: | Background: Thrombocytopenia represents the main cause of stopping alkylating chemotherapy for toxicity. Here, we explored the incidence, and the consequences for treatment exposure and survival, of thrombocytopenia induced by lomustine in recurrent glioblastoma. Methods: We performed a retrospective analysis of the associations of thrombocytopenia with treatment delivery and outcome in EORTC 26101, a randomised trial designed to define the role of lomustine versus bevacizumab versus their combination in recurrent glioblastoma. Results: A total of 225 patients were treated with lomustine alone (median 1 cycle) (group 1) and 283 patients were treated with lomustine plus bevacizumab (median 3 lomustine cycles) (group 2). Among cycle delays and dose reductions of lomustine for toxicity, thrombocytopenia was the leading cause. Among 129 patients (57%) of group 1 and 187 patients (66%) of group 2 experiencing at least one episode of thrombocytopenia, 36 patients (16%) in group 1 and 93 (33%) in group 2 had their treatment modified because of thrombocytopenia. Lomustine was discontinued for thrombocytopenia in 16 patients (7.1%) in group 1 and in 38 patients (13.4%) in group 2. On adjusted analysis accounting for major prognostic factors, dose modification induced by thrombocytopenia was associated with inferior progression-free survival in patients with MGMT promoter-methylated tumours in groups 1 and 2. This effect was noted for overall survival, too, but only for group 2 patients. Conclusion: Drug-induced thrombocytopenia is a major limitation to adequate exposure to lomustine chemotherapy in recurrent glioblastoma. Mitigating thrombocytopenia to enhance lomustine exposure might improve outcome in patients with MGMT promoter-methylated tumours. (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| فهرسة مساهمة: | Keywords: CCNU; Chemotherapy; Myelosuppression; Platelets; Toxicity; Transfusion |
| المشرفين على المادة: | 2S9ZZM9Q9V (Bevacizumab) 7BRF0Z81KG (Lomustine) |
| تواريخ الأحداث: | Date Created: 20221115 Date Completed: 20221223 Latest Revision: 20230313 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.ejca.2022.10.006 |
| PMID: | 36379185 |
| قاعدة البيانات: | MEDLINE |
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