NDLI: Comparison of the clinical efficacy of temozolomide (TMZ) versus nimustine (ACNU)-based chemotherapy in newly diagnosed glioblastoma.

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Comparison of the clinical efficacy of temozolomide (TMZ) versus nimustine (ACNU)-based chemotherapy in newly diagnosed glioblastoma.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Wang, Yongzhi Chen, Xuzhu Zhang, Zhong Li, Shouwei Chen, Baoshi Wu, Chenxing Wang, Lei Zhang, Xinzhong Wang, Jiayin Chen, Ling Jiang, Tao
Description	Country affiliation: China Author Affiliation: Wang Y ( Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.)
Abstract	Although temozolomide (TMZ) replaced nitrosoureas as the standard initial chemotherapy for glioblastoma (GBM), no studies have compared TMZ with nimustine (ACNU), a nitrosourea agent widely used in central Europe and most Asian regions. One hundred thirty-five patients with GBM who underwent extensive tumor resection in our institution received both radiation and chemotherapy as initial treatment, 34 received TMZ and 101 ACNU-based (ACNU plus teniposide or cisplatin) chemotherapy. Efficacy analysis included overall survival (OS) and progression-free survival (PFS). The following prognostic factors were taken into account: age, performance status, extent of resection, and O(6)-methylguanine-DNA-methyltransferase (MGMT) gene status. The median OS was superior in the TMZ versus the ACNU group (p = 0.011), although MGMT gene silencing, which is associated with a striking survival benefit from alkylating agents, was more frequent in the ACNU group. In multivariate Cox analysis adjusting for the common prognostic factors, TMZ chemotherapy independently predicted a favorable outcome (p = 0.002 for OS, hazard ratio [HR], 0.45; p = 0.011 for PFS, HR, 0.56). Given that >40 % of patients in ACNU group did not receive the intensive chemotherapy cycles because of severe hematological and nonhematological toxicity, we performed a further subanalysis for patients who received at least 4 cycles of chemotherapy. Although a modest improvement in survival occurred in this ACNU subgroup, the efficacy was still inferior to that in the TMZ cohort. Our data suggest that the survival benefit of TMZ therapy is superior to that of an ACNU-based regimen in patients with extensive tumor resection, also shows greater tolerability.
File Format	HTM / HTML
ISSN	03445607
Issue Number	1
Volume Number	37
e-ISSN	14372320
Journal	Neurosurgical Review
Language	English
Publisher	Springer
Publisher Date	2014-01-01
Publisher Place	Germany
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Neurosurgery Antineoplastic Agents, Alkylating Therapeutic Use Antineoplastic Agents Brain Neoplasms Drug Therapy Dacarbazine Analogs & Derivatives Glioblastoma Nimustine Adolescent Adult Aged Adverse Effects Pathology Therapy Chemoradiotherapy, Adjuvant Combined Modality Therapy Dna Modification Methylases Genetics Dna Repair Enzymes Female Humans Kaplan-meier Estimate Karnofsky Performance Status Male Middle Aged Survival Analysis Tumor Suppressor Proteins Young Adult Comparative Study Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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