Comparison of the clinical efficacy of temozolomide (TMZ) versus nimustine (ACNU)-based chemotherapy in newly diagnosed glioblastoma

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• 作者：Yongzhi Wang (1)
  Xuzhu Chen (2)
  Zhong Zhang (1)
  Shouwei Li (3)
  Baoshi Chen (1)
  Chenxing Wu (3)
  Lei Wang (1)
  Xinzhong Zhang (4)
  Jiayin Wang (5)
  Ling Chen (5)
  Tao Jiang (1) (6)
  
• 关键词：Glioblastoma ; Adjuvant chemotherapy ; Nimustine (ACNU) ; Temozolomide (TMZ) ; Survival
• 刊名：Neurosurgical Review
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：37
• 期：1
• 页码：73-78
• 全文大小：208 KB
• 作者单位：Yongzhi Wang (1)
  Xuzhu Chen (2)
  Zhong Zhang (1)
  Shouwei Li (3)
  Baoshi Chen (1)
  Chenxing Wu (3)
  Lei Wang (1)
  Xinzhong Zhang (4)
  Jiayin Wang (5)
  Ling Chen (5)
  Tao Jiang (1) (6)
  
  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
  2. Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
  3. Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
  4. Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, No. 88 Healthy Road, Weihui, Henan Province, 453100, China
  5. Department of Neurosurgery and Cell Therapy Center, Xuanwu Hospital, Capital Medical University, No.45, Changchun Street,, Xicheng District, Beijing, 100053, China
  6. Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, No.6 Tiantan Xili,, Dongcheng District, Beijing, 100050, China
  
• ISSN：1437-2320

文摘

Although temozolomide (TMZ) replaced nitrosoureas as the standard initial chemotherapy for glioblastoma (GBM), no studies have compared TMZ with nimustine (ACNU), a nitrosourea agent widely used in central Europe and most Asian regions. One hundred thirty-five patients with GBM who underwent extensive tumor resection in our institution received both radiation and chemotherapy as initial treatment, 34 received TMZ and 101 ACNU-based (ACNU plus teniposide or cisplatin) chemotherapy. Efficacy analysis included overall survival (OS) and progression-free survival (PFS). The following prognostic factors were taken into account: age, performance status, extent of resection, and O6-methylguanine-DNA-methyltransferase (MGMT) gene status. The median OS was superior in the TMZ versus the ACNU group (p--.011), although MGMT gene silencing, which is associated with a striking survival benefit from alkylating agents, was more frequent in the ACNU group. In multivariate Cox analysis adjusting for the common prognostic factors, TMZ chemotherapy independently predicted a favorable outcome (p--.002 for OS, hazard ratio [HR], 0.45; p--.011 for PFS, HR, 0.56). Given that >40?% of patients in ACNU group did not receive the intensive chemotherapy cycles because of severe hematological and nonhematological toxicity, we performed a further subanalysis for patients who received at least 4?cycles of chemotherapy. Although a modest improvement in survival occurred in this ACNU subgroup, the efficacy was still inferior to that in the TMZ cohort. Our data suggest that the survival benefit of TMZ therapy is superior to that of an ACNU-based regimen in patients with extensive tumor resection, also shows greater tolerability.