ANAHEIM, CALIFORNIA—For patients with recurrent glioblastoma, carboplatin-based intra-arterial chemotherapy is relatively safe and well-tolerated, with quality of life being maintained or improved during treatment. This study was presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
“Glioblastomas are the most aggressive brain tumor, and roughly 60% of all brain tumors are glioblastomas. Median survival is 14 to 16 months, with a nearly 100% recurrence rate,” Patricia Bruns, RN, MSN, APN, CNS, of the Minneapolis Clinic of Neurology, said during a podium session. “Despite treatment with radiation and chemotherapy, it remains a devastating diagnosis and recurrence remains a clinical conundrum.”
Standard of care for glioblastoma includes 3D-conformal radiation over 6 weeks with concurrent temozolomide. This is followed by at least 12 cycles of adjuvant temolozomide for 5 days followed by 23 days without treatment. Patients undergo close follow-up with MRI and have office visits at least every 8 weeks or at shorter intervals, depending on their MRI results.
When tumor recurrence occurs, options are limited, according to Bruns. Although many patients attempt other treatments, a vast majority at Bruns’ institution receive intra-arterial chemotherapy. For this treatment, a catheter is threaded via the femoral artery to the base of the skull, and chemotherapy is injected into the brain through vessels that feed the tumor.
To evaluate the survival benefit and toxicity profile of this treatment, Bruns and colleagues conducted a retrospective chart review of patients with recurrent glioblastoma who were treated with intra-arterial carboplatin with either bevacizumab (group A) or intra-arterial carboplatin with intravenous chemotherapy agents (group B) from November 2005 to May 2010.
Forty-four patients (average age, 52.5 years; 29 men) were included in the analysis. Thirty were at their first recurrence, 13 were at their second recurrence, and one was at a third recurrence. In terms of the extent of surgery, 25 had undergone complete resection, 11 had undergone partial resection, and eight had undergone biopsies.
According to the data, adverse events included growing hematomas, seizures, headaches, nausea, and myelosuppression.
Progression-free survival was roughly 162 days (5.4 months) in group A versus 237 days (7.9 months) in group B. In patients treated with bevacizumab alone, progression-free survival was roughly 120 days (4 months).
Overall survival was 20.7 months in group A and 16.2 months in group B, which bypassed the average life expectancy for these patients.
Bruns and colleagues also sought to examine how carboplatin-based intra-arterial chemotherapy affected health-related quality of life. Patients had to have received and failed standard of care for glioblastoma. Those with bilateral disease, those who are immediately post-radiation, and those with comorbid conditions were excluded.
The study measured quality of life at baseline and 1, 2, and 4 months after therapy. The researchers have enrolled 20 patients to date, and 14 have currently completed a minimum of 4 months of treatment. During her presentation, Bruns discussed results of an interim analysis of these patients.
Patients were relatively younger, aged 34 to 67 years. Time since initial diagnosis ranged from 7 to 68 months. Adverse events included hematoma, a varicella outbreak related to myelosuppression, headaches, nausea, fatigue, which is an ongoing issue, and stroke in one patient.
Seven quality of life domains were examined, including global quality of life, role function, social function, visual disorder, motor dysfunction, communication deficit, and drowsiness.
Results revealed improvements in global quality of life, role function, and social function scores from baseline through follow-up, with the exception of social function at month 4. Visual disorder, motor dysfunction, communication deficit, and drowsiness typically decreased as time went by.
“Intra-arterial chemotherapy with carboplatin is relatively safe and well-tolerated. In this small study cohort, no major treatment-related adverse events occurred and we did not see any significant detrimental effects on quality of life scores in any of the seven preselected domains. Rather, there was an improvement in global quality of life and role function scores in the majority of patients,” Bruns concluded.
Bruns P. Effect of intra-arterial chemotherapy treatment on health-related quality of life in patients with recurrent high-grade glioma. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.