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High Dose Methotrexate Has Modest Toxicity Among CNS Lymphoma Cohort
A DGReview of :"Treatment of Primary CNS Lymphoma With Methotrexate and Deferred Radiotherapy: A Report of NABTT 96-07"
Journal of Clinical Oncology (JCO)
03/26/2003
By Harvey McConnell
High-dose methotrexate produces modest toxicity and a radiographic response proportion of 74% among patients with primary central nervous system lymphomas. say researchers.
These findings are reported by Dr T Batchelor and colleagues from Massachusetts General Hospital, Boston, United States, as a result of a multi-centre, phase II study of single-agent, intravenous methotrexate among patients with newly diagnosed non-AIDS-related primary CNS lymphoma in the New Approaches to Brain Tumor Therapy (NABTT) CNS Consortium.
Twenty five patients, mean age 60 years, were given methotrexate at 8 g/mē, initially administered every two weeks. The primary end point was radiographic complete response (CR) or partial response (PR), as defined by standard radiographic criteria. Secondary endpoints were drug-related toxicity and survival.
The patients all had median Karnofsky Performance Score of 80. Three of 14 patients who underwent lumbar puncture had malignant cells on CSF cytopathology, and 5 of the 25 patients had ocular involvement. Two patients could not be evaluated for the primary end point because one did not have any measurable disease, and the second died before radiologic imaging.
All patients either completed the treatment program, or progressed with treatment. Among 23 of the patients, there was a complete response among 12 (52%), a partial response among 5 (22%), 1 (4%) had disease stability, and 5 (22%) had progression while receiving therapy.
Seven of the patients eventually died from progression of their tumour, while 2 died of other causes. Median progression-free survival was 12.8 months, and the median overall survival for the entire group had not been reached at 22.8+ months.
The clinicians found following 287 cycles of chemotherapy, that toxicity was modest following the methotrexate regimen, and with no grade 3 or 4 toxicity in 13 of 25 patients. There was a grade 3 toxicity among eight of 25 patients, and a grade 4 toxicity among four of 25 patients.
J Clin Oncol 2003 Mar;21:6:1044-9.
"Treatment of Primary CNS Lymphoma With Methotrexate and Deferred Radiotherapy: A Report of NABTT 96-07"
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