Anaplastic astrocytoma and glioblastoma

Adjuvant chemoradiation

Temozolomide + RT
Radiotherapy to 60 Gy
Concurrent temozolomide (Temodar) 75 mg/m2 po qd
4 weeks after radiation, continue temozolomide 150-200 mg/m2 po qd x 5 days every month.

Stupp, R et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352:987 (link to the article)

Adjuvant chemotherapy (back to top)

Temozolomide
Temozolomide (Temodar) 200 mg/m2/d po d1-5
Q4w x 8 cycles

Wick Wolfgang W et al. Randomized phase III study of sequential radiochemotherapy of oligoastrocytic  tumors of WHO-grade III with PCV or temozolomide: NOA-04. 2008 ASCO annual meeting. LBA2007 (link to the abstract).

Carmustine (BCNU) 
Carmustine (BCNU) 150-200 mg/m2 iv d1
Q6w

Shapiro WR et al. Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 1989; 71:1 (link to the article).

PCV regimen 1
Procarbazine 100 mg/m2 po qd d1-10
Lomustine 100 mg/m2 po d1
Vincristine 1.5 mg/m2 (maximum 2 mg) iv d8, 29
Q6w x 12 cycles

Randomized trial of procarbazine, lomustine and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial. J Clin Oncol 2001; 19:509 (link to the article).

PCV regimen 2
Procarbazine 60 mg/m2 po qd d8-21
Lomustine 110 mg/m2 po d1
Vincristine 1.4 mg/m2 (maximum 2 mg) iv d8, 29
Q6-8w x 6 cycles

Levin, VA et al. Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiat Oncol Biol Phys 1990; 18:321 (link to the article).

Chemotherapy for recurrent and progressive cancer (back to top)

Temozolomide
Temozolomide (Temodar) 150-200 mg/m2/d po d1-5 or 150 mg/m2/d po d1-7 and 15-21
Q4w

Wick A et al. Efficacy and tolerability of temozolomide in an alternating weekly regimen in patients with recurrent glioma. J Clin Oncol 2007; 25:3357 (link to the article). 

Yung, WK et al. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol 1999; 17:2762 (link to the article).

Carmustine (BCNU) 
Carmustine (BCNU) 80 mg/m2 iv d1-3
Q8w x 6 cycles
 
Brandes, AA et al. How effective is BCNU in recurrent glioblastoma in the modern era? A phase II trial. Neurology 2004; 63:1281
(link to the article).

Procarbazine
Procarbazine 125-150 mg/m2, po d1-28
Repeat every 56 days

Yung, WK et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 2000; 83:588
(link to the article).

Irinotecan
Irinotecan (Camptosar, CPT-11) 125 mg/m2 iv qw for 4 weeks
Q6w

Friedman, HS et al. Irinotecan treatment of adults with recurrent or progressive malignant glioma. J Clin Oncol 1999; 17:1516 (link to the article).

Irinotecan + Bevacizumab
Irinotecan (Camptosar, CPT-11) 125 mg/m2 (non EIAED) or 340 mg/m2 (EIAED) iv over 90 min
Bevacizumab (Avastin) 10 mg/kg iv over 30-90 min
Q2w

Vredenburgh JJ et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 2007; 25:4722 (link to the article). 

Chen W et al. Predicting treatment response of malignant gliomas to bevacizumab and irinotecan by imaging proliferation with [18F] fluorothymidine positron emission tomography: a pilot study. J Clin Oncol 2007; 25:4714 (link to the article).  

Goli KJ et al. Phase II trial of bevacizumab and irinotecan in the treatment of malignant gliomas. 2007 ASCO annual meeting. Abstract 2003 (link to the abstract). 

PCV
Procarbazine 60 mg/m2 po qd d8-21
Lomustine 110 mg/m2 po d1
Vincristine 1.4 mg/m2 (maximum 2 mg) iv d8, 29
Q6w

Kappelle, AC et al. PCV chemotherapy for recurrent glioblastoma multiforme. Neurology 2001; 56:118 (link to the article).

Anaplastic oligodendroglioma (back to top)

Chemotherapy for recurrent and progressive cancer 

PCV
Procarbazine 60 mg/m2 po qd d8-21
Lomustine 110 mg/m2 po d1
Vincristine 1.4 mg/m2 (maximum 2 mg) iv d8, 29
Q6w

Brandes, AA et al. Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy. A Phase II study. Cancer 2004; 101:2079 (link to the article).

Temozolomide
Temozolomide (Temodar) 150-200 mg/m2 po d1-5
Q4w

Chinot, JL et al. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol 2001; 19:2449 (link to the article).