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
Notes: J. Neuro-Oncol. -- Export Date: 8 July 2014 -- CODEN: JNODD -- Source: Scopus
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MSK Authors
  1. Antonio Marcilio Padula Omuro
    177 Omuro