A phase II study of surgical excision, temozolomide, radiotherapy, and anti-EGFR radioimmunotherapy (EXTRA) as adjuvant therapy in high-grade gliomas
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- 作者：Larry C. Daugherty (1)
Brandon J. Fisher (2)
Steven Morales (3)
Ji Kim (4)
Linna Li (5)
Tony S. Quang (6)
Jacqueline Emrich (3)
Theodore Yaeger (7)
Joseph M. Jenrette (8)
Steven Cohen (9)
Lydia T. Komarnicky (3)
Katherine Tzou (1)
Jennifer Peterson (1)
Luther W. Brady (3) - 关键词：Glioblastoma multiforme ; Glioma ; Gliomas ; Temozolomide ; Radioimmunotherapy
- 刊名：Journal of Radiation Oncology
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：3
- 期：4
- 页码：347-353
- 全文大小：564 KB
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19. Brady LW (1998) A new treatment for high grade gliomas of the brain. - 作者单位：Larry C. Daugherty (1)
Brandon J. Fisher (2)
Steven Morales (3)
Ji Kim (4)
Linna Li (5)
Tony S. Quang (6)
Jacqueline Emrich (3)
Theodore Yaeger (7)
Joseph M. Jenrette (8)
Steven Cohen (9)
Lydia T. Komarnicky (3)
Katherine Tzou (1)
Jennifer Peterson (1)
Luther W. Brady (3)
1. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
2. Gamma West Cancer Services, St. George, UT, USA
3. Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA, USA
4. Department of Radiation Oncology, City of Hope Cancer Center, Duarte, CA, USA
5. Department of Radiation Oncology, Bryn Mawr Hospital, Bryn Mawr, PA, USA
6. Department of Radiation Oncology, VA Puget Sound Health Care System/University of Washington, Seattle, WA, USA
7. Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
8. Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
9. Department of Neurosurgery, Bryn Mawr Hospital, Bryn Mawr, PA, USA - ISSN：1948-7908
文摘
Objective Despite evolution in surgical technique, radiotherapy technology, and targeted systemic therapies, prognosis for patients with high-grade gliomas remains poor. Standard treatment consisting of surgery, adjuvant chemoradiation, and chemotherapy has marginally improved survival in these patients. A recent novel approach has been the addition of adjuvant radioimmunotherapy with 125I-labeled anti-epidermal growth factor receptor monoclonal antibody 425 (125I-epidermal growth factor receptor (EGFR) monoclonal antibody (MAb) 425), which demonstrated safety and efficacy in patients with glioblastoma. Many institutions choose to treat grade 3 gliomas in an identical fashion to grade 4 tumors. In this phase II clinical trial, we tested the efficacy of adjuvant radioimmunotherapy in patients with pathologic diagnosis of high-grade glioma comprising either glioblastoma (GBM) or astrocytoma with anaplastic foci (AAF). Methods Patients with newly diagnosed high-grade gliomas were eligible. Adjuvant radiotherapy was delivered with a median dose of 60?Gy after surgery. 125I-EGFR MAb 425 was given by three weekly intravenous injections of 1.85?GBq of radiolabeled 125I-EGFR MAb 425 following surgery and adjuvant radiation. When administered, temozolomide was given concominantly (75?mg/m2/day, 35-2?days) with radiotherapy followed by 6?cycles of adjuvant temozolomide (TMZ) (150-00?mg/m2/day?×-?days, every 28?days q28d). Median survival was the primary endpoint. We compared survival in three treatment groups: patients who underwent surgery followed by radiation (CTL), patients who underwent surgery and radiation followed by radioimmunotherapy (RIT), and patients who underwent RIT with the additional of temozolomide (RIT + TMZ). Results Between 1988 and 2008, a total of 390 patients with high-grade glioma underwent treatment at Hahnemann University Hospital with a median age of 48?years. Median survival in months was 7.3, 39.7, and 79.4 in the CTL, RIT, and RIT + TMZ arms, respectively. Multivariate analysis, which controlled for age and extent of surgery, demonstrated a persistent survival benefit of RIT. Combined results are reported as well as subgroup analysis of GBM and AAF patients. Conclusion Adjuvant 125I-EGFR MAb 425 radioimmunotherapy is a safe and effective treatment for patients with high-grade glioma and warrants further study with a randomized trial.