A phase I trial of lenalidomide and radiotherapy in children with diffuse intrinsic pontine gliomas or high-grade gliomas Journal Article

Authors: Hipp, S. J.; Goldman, S.; Kaushal, A.; Krauze, A.; Citrin, D.; Glod, J.; Walker, K.; Shih, J. H.; Sethumadhavan, H.; O’Neill, K.; Garvin, J. H.; Glade-Bender, J.; Karajannis, M. A.; Atlas, M. P.; Odabas, A.; Rodgers, L. T.; Peer, C. J.; Savage, J.; Camphausen, K. A.; Packer, R. J.; Figg, W. D.; Warren, K. E.
Article Title: A phase I trial of lenalidomide and radiotherapy in children with diffuse intrinsic pontine gliomas or high-grade gliomas
Abstract: Purpose: This study was performed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of the immunomodulatory agent, lenalidomide, when administered daily during 6 weeks of radiation therapy to children with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG) Patients & methods: Children and young adults < 22 years of age with newly diagnosed disease and no prior chemotherapy or radiation therapy were eligible. Children with HGG were required to have an inoperable or incompletely resected tumor. Eligible patients received standard radiation therapy to a prescription dose of 54–59.4 Gy, with concurrent administration of lenalidomide daily during radiation therapy in a standard 3 + 3 Phase I dose escalation design. Following completion of radiation therapy, patients had a 2-week break followed by maintenance lenalidomide at 116 mg/m2/day × 21 days of a 28-day cycle. Results: Twenty-nine patients (age range 4–19 years) were enrolled; 24 were evaluable for dose finding (DIPG, n = 13; HGG, n = 11). The MTD was not reached at doses of lenalidomide up to 116 mg/m2/day. Exceptional responses were noted in DIPG and malignant glioma (gliomatosis cerebri) notably at higher dose levels and at higher steady state plasma concentrations. The primary toxicity was myelosuppression. Conclusion: The RP2D of lenalidomide administered daily during radiation therapy is 116 mg/m2/day. Children with malignant gliomas tolerate much higher doses of lenalidomide during radiation therapy compared to adults. This finding is critical as activity was observed primarily at higher dose levels suggesting a dose response. © 2020, This is a U.S. Government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
Keywords: lenalidomide; radiation; pediatric neuro-oncology; high grade glioma; diffuse intrinsic pontine glioma
Journal Title: Journal of Neuro-Oncology
Volume: 149
Issue: 3
ISSN: 0167-594X
Publisher: Springer  
Date Published: 2020-09-01
Start Page: 437
End Page: 445
Language: English
DOI: 10.1007/s11060-020-03627-0
PUBMED: 33040274
PROVIDER: scopus
PMCID: PMC7690216
Notes: Article -- Export Date: 1 December 2020 -- Source: Scopus
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