Methotrexate re-challenge for recurrent primary central nervous system lymphoma Journal Article
| Authors: | Pentsova, E.; Deangelis, L. M.; Omuro, A. |
| Article Title: | Methotrexate re-challenge for recurrent primary central nervous system lymphoma |
| Abstract: | The prognosis of primary CNS lymphoma (PCNSL) recurring after methotrexate is poor (objective response rates [ORR] = 26-53 %; 1-year overall survival [OS] = 35-57 %). Salvage PCNSL chemotherapies have been based on the use of different agents to avoid cross-resistance; however, methotrexate is the most active agent in PCNSL, and methotrexate re-challenge may be an effective strategy for recurrent disease. We report our experience with methotrexate re-challenge in PCNSL. We reviewed 39 patients with histologically confirmed PCNSL who responded to methotrexate at initial diagnosis, experienced disease relapse and received methotrexate re-challenge. At the time of re-challenge, median age was 66 and median Karnofsky performance score (KPS) was 70. Median time from initial diagnosis was 26 m. Twenty-six patients were at first relapse and 13 at second or later relapse. At re-challenge, methotrexate was given in combination with other agents to 33 patients and as a single agent to six. The objective response rate was 85 %, with a complete response in 29 (75 %) patients, partial response in four (10 %) and disease progression in six (15 %). At median follow-up of 26 m, the median progression-free survival was 16 m; 1-year OS was 79 % (95 % CI 63-89) and median OS was 41 m. KPS was a prognostic factor for progression free survival (p = 0.04). In this population selected by previous methotrexate response, methotrexate re-challenge was a safe and effective strategy, indicating chemosensitivity was retained. Efficacy compared favorably to other salvage treatments suggesting methotrexate re-challenge should be considered in recurrent PCNSL patients who previously responded to methotrexate. © 2014 Springer Science+Business Media New York. |
| Keywords: | adult; clinical article; aged; overall survival; fatigue; neutropenia; cancer recurrence; cancer growth; drug withdrawal; unspecified side effect; primary central nervous system lymphoma; methotrexate; rituximab; temozolomide; neurotoxicity; progression free survival; infection; lung toxicity; nephrotoxicity; blood toxicity; neuropathy; thrombocytopenia; recurrence; vincristine; deep vein thrombosis; kidney failure; procarbazine; hyponatremia; karnofsky performance status; drug response; primary cns lymphoma; leukoencephalopathy; cancer prognosis; very elderly; drug rechallenge; human; male; female; article |
| Journal Title: | Journal of Neuro-Oncology |
| Volume: | 117 |
| Issue: | 1 |
| ISSN: | 0167-594X |
| Publisher: | Springer |
| Date Published: | 2014-03-01 |
| Start Page: | 161 |
| End Page: | 165 |
| Language: | English |
| DOI: | 10.1007/s11060-014-1370-0 |
| PROVIDER: | scopus |
| PUBMED: | 24481997 |
| PMCID: | PMC5256683 |
| DOI/URL: | |
| Notes: | J. Neuro-Oncol. -- Export Date: 8 July 2014 -- CODEN: JNODD -- Source: Scopus |
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132Pentsova
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