Introduction: : The first-line treatment of Glioblastoma typically consist of a maximal surgical resection, followed by a combination of radio-chemotherapy with temozolomide. There is however no consensus regarding optimal therapeutic approaches at relapse. The following phase II study explored the therapeutic gain obtained when exposing these patients to a combination of intra-arterially administered carboplatin and melphalan at first or second relapse.
Methods: Fifty-one consecutive patients diagnosed with glioblastoma were accrued and offered this treatment at first or second relapse. A Karnosfsy score of > 60 was required, and when appropriate, patients were first reoperated prior to accrual. Patients enrolled were treated every four weeks (1 cycle) for up to 12 cycles. Progression was evaluated by the MacDonald criteria. Primary end point surrogates were overall survival from diagnosis and study entry, and longitudinal QOL during treatment was assessed as a secondary endpoint.
Results: Median survival from diagnosis and study entry were 23 and 11 months, respectively. Time to progression was 5,2 months. All patients enrolled were treated for a minimum of 2 cycles. Hematologic toxicity was manageable, with a 8% of grade II neutropenia , 12% of grade II thrombocytopenia and 7% of grade III thrombocytopenia.
Conclusions: These encouraging results prompted us to design a randomized study, comparing this treatment modality to CCNU at first or second relapse.
Patient Care: This abstract report a new option for recurring GBM patients thta clearly extend survival, without impacting unfavorably quality of life
Learning Objectives: Intra-arterial chemotherapy is secure and doable in a standardized context.
By improving delivery of otherwise poorly CNS penetrating chemotherapy agents,intra-arterial chemotherapy infusion increases the number of therapeutic options for patients presenting GBM recurrence.
This regimen represent a good salvage regimen at tumor recurence