Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas

Howard A. Fine, William D. Figg, Kurt Jaeckle, Patrick Y. Wen, Athanassios P. Kyritsis, Jay S. Loeffler, Victor A. Levin, Peter M. Black, Richard Kaplan, James M. Pluda, W. K.Alfred Yung

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Abstract

Purpose: Little progress has been made in the treatment of adult high- grade gliomas over the last two decades, thus necessitating a search far novel therapeutic strategies. Malignant gliomas are vascular or angiogenic tumors, which leads to the supposition that angiogenesis inhibition may represent a potentially promising strategy in the treatment of these tumors. We present the results of a phase II trial of thalidomide, a putative inhibitor of angiogenesis, in the treatment of adults with previously irradiated, recurrent high-grade gliomas. Patients and Methods: Patients with a histologic diagnosis of anaplastic mixed glioma, anaplastic astrocytoma, or glioblastoma multiforme who had radiographic demonstration of tumor progression after standard external-beam radiotherapy with or without chemotherapy were eligible. Patients were initially treated with thalidomide 800 mg/d with increases in dose by 200 mg/d every 2 weeks until a final daily dose of 1,200 mg was achieved. Patients were evaluated every 8 weeks for response by both clinical and radiographic criteria. Results: A total of 39 patients were accrued, with 36 patients being assessable for both toxicity and response. Thalidomide was well tolerated, with constipation and sedation being the major toxicities. One patient developed a grade 2 peripheral neuropathy after treatment with thalidomide for nearly a year. There were two objective radiographic partial responses (6%), two minor responses (6%), and 12 patients with stable disease (33%). Eight patients were alive more than I year after starting thalidomide, although almost all with tumor progression. Changes in serum levels of basic fibroblastic growth factor (bFGF) were correlated with time to tumor progression and overall survival. Conclusion: Thalidomide is a generally well-tolerated drug that may have antitumor activity in a minority of patients with recurrent high-grade gliomas. Future studies will better define the usefulness of thalidomide in newly diagnosed patients with malignant gliomas and in combination with radiotherapy and chemotherapy. Additionally, studies will be needed to confirm the potential utility of changes in serum bFGF as a marker of antiangiogenic activity and/or glioma growth. (C) 2000 American Society of Clinical Oncology.

Original languageEnglish (US)
Pages (from-to)708-715
Number of pages8
JournalJournal of Clinical Oncology
Volume18
Issue number4
StatePublished - Feb 1 2000

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Thalidomide
Angiogenesis Inhibitors
Glioma
Neoplasms
Intercellular Signaling Peptides and Proteins
Radiotherapy
Therapeutics
Drug Therapy
Astrocytoma
Peripheral Nervous System Diseases
Constipation
Glioblastoma
Serum
Blood Vessels

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Fine, H. A., Figg, W. D., Jaeckle, K., Wen, P. Y., Kyritsis, A. P., Loeffler, J. S., ... Yung, W. K. A. (2000). Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas. Journal of Clinical Oncology, 18(4), 708-715.
Fine, Howard A. ; Figg, William D. ; Jaeckle, Kurt ; Wen, Patrick Y. ; Kyritsis, Athanassios P. ; Loeffler, Jay S. ; Levin, Victor A. ; Black, Peter M. ; Kaplan, Richard ; Pluda, James M. ; Yung, W. K.Alfred. / Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas. In: Journal of Clinical Oncology. 2000 ; Vol. 18, No. 4. pp. 708-715.
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abstract = "Purpose: Little progress has been made in the treatment of adult high- grade gliomas over the last two decades, thus necessitating a search far novel therapeutic strategies. Malignant gliomas are vascular or angiogenic tumors, which leads to the supposition that angiogenesis inhibition may represent a potentially promising strategy in the treatment of these tumors. We present the results of a phase II trial of thalidomide, a putative inhibitor of angiogenesis, in the treatment of adults with previously irradiated, recurrent high-grade gliomas. Patients and Methods: Patients with a histologic diagnosis of anaplastic mixed glioma, anaplastic astrocytoma, or glioblastoma multiforme who had radiographic demonstration of tumor progression after standard external-beam radiotherapy with or without chemotherapy were eligible. Patients were initially treated with thalidomide 800 mg/d with increases in dose by 200 mg/d every 2 weeks until a final daily dose of 1,200 mg was achieved. Patients were evaluated every 8 weeks for response by both clinical and radiographic criteria. Results: A total of 39 patients were accrued, with 36 patients being assessable for both toxicity and response. Thalidomide was well tolerated, with constipation and sedation being the major toxicities. One patient developed a grade 2 peripheral neuropathy after treatment with thalidomide for nearly a year. There were two objective radiographic partial responses (6{\%}), two minor responses (6{\%}), and 12 patients with stable disease (33{\%}). Eight patients were alive more than I year after starting thalidomide, although almost all with tumor progression. Changes in serum levels of basic fibroblastic growth factor (bFGF) were correlated with time to tumor progression and overall survival. Conclusion: Thalidomide is a generally well-tolerated drug that may have antitumor activity in a minority of patients with recurrent high-grade gliomas. Future studies will better define the usefulness of thalidomide in newly diagnosed patients with malignant gliomas and in combination with radiotherapy and chemotherapy. Additionally, studies will be needed to confirm the potential utility of changes in serum bFGF as a marker of antiangiogenic activity and/or glioma growth. (C) 2000 American Society of Clinical Oncology.",
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Fine, HA, Figg, WD, Jaeckle, K, Wen, PY, Kyritsis, AP, Loeffler, JS, Levin, VA, Black, PM, Kaplan, R, Pluda, JM & Yung, WKA 2000, 'Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas', Journal of Clinical Oncology, vol. 18, no. 4, pp. 708-715.

Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas. / Fine, Howard A.; Figg, William D.; Jaeckle, Kurt; Wen, Patrick Y.; Kyritsis, Athanassios P.; Loeffler, Jay S.; Levin, Victor A.; Black, Peter M.; Kaplan, Richard; Pluda, James M.; Yung, W. K.Alfred.

In: Journal of Clinical Oncology, Vol. 18, No. 4, 01.02.2000, p. 708-715.

Research output: Contribution to journalArticle

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T1 - Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas

AU - Fine, Howard A.

AU - Figg, William D.

AU - Jaeckle, Kurt

AU - Wen, Patrick Y.

AU - Kyritsis, Athanassios P.

AU - Loeffler, Jay S.

AU - Levin, Victor A.

AU - Black, Peter M.

AU - Kaplan, Richard

AU - Pluda, James M.

AU - Yung, W. K.Alfred

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N2 - Purpose: Little progress has been made in the treatment of adult high- grade gliomas over the last two decades, thus necessitating a search far novel therapeutic strategies. Malignant gliomas are vascular or angiogenic tumors, which leads to the supposition that angiogenesis inhibition may represent a potentially promising strategy in the treatment of these tumors. We present the results of a phase II trial of thalidomide, a putative inhibitor of angiogenesis, in the treatment of adults with previously irradiated, recurrent high-grade gliomas. Patients and Methods: Patients with a histologic diagnosis of anaplastic mixed glioma, anaplastic astrocytoma, or glioblastoma multiforme who had radiographic demonstration of tumor progression after standard external-beam radiotherapy with or without chemotherapy were eligible. Patients were initially treated with thalidomide 800 mg/d with increases in dose by 200 mg/d every 2 weeks until a final daily dose of 1,200 mg was achieved. Patients were evaluated every 8 weeks for response by both clinical and radiographic criteria. Results: A total of 39 patients were accrued, with 36 patients being assessable for both toxicity and response. Thalidomide was well tolerated, with constipation and sedation being the major toxicities. One patient developed a grade 2 peripheral neuropathy after treatment with thalidomide for nearly a year. There were two objective radiographic partial responses (6%), two minor responses (6%), and 12 patients with stable disease (33%). Eight patients were alive more than I year after starting thalidomide, although almost all with tumor progression. Changes in serum levels of basic fibroblastic growth factor (bFGF) were correlated with time to tumor progression and overall survival. Conclusion: Thalidomide is a generally well-tolerated drug that may have antitumor activity in a minority of patients with recurrent high-grade gliomas. Future studies will better define the usefulness of thalidomide in newly diagnosed patients with malignant gliomas and in combination with radiotherapy and chemotherapy. Additionally, studies will be needed to confirm the potential utility of changes in serum bFGF as a marker of antiangiogenic activity and/or glioma growth. (C) 2000 American Society of Clinical Oncology.

AB - Purpose: Little progress has been made in the treatment of adult high- grade gliomas over the last two decades, thus necessitating a search far novel therapeutic strategies. Malignant gliomas are vascular or angiogenic tumors, which leads to the supposition that angiogenesis inhibition may represent a potentially promising strategy in the treatment of these tumors. We present the results of a phase II trial of thalidomide, a putative inhibitor of angiogenesis, in the treatment of adults with previously irradiated, recurrent high-grade gliomas. Patients and Methods: Patients with a histologic diagnosis of anaplastic mixed glioma, anaplastic astrocytoma, or glioblastoma multiforme who had radiographic demonstration of tumor progression after standard external-beam radiotherapy with or without chemotherapy were eligible. Patients were initially treated with thalidomide 800 mg/d with increases in dose by 200 mg/d every 2 weeks until a final daily dose of 1,200 mg was achieved. Patients were evaluated every 8 weeks for response by both clinical and radiographic criteria. Results: A total of 39 patients were accrued, with 36 patients being assessable for both toxicity and response. Thalidomide was well tolerated, with constipation and sedation being the major toxicities. One patient developed a grade 2 peripheral neuropathy after treatment with thalidomide for nearly a year. There were two objective radiographic partial responses (6%), two minor responses (6%), and 12 patients with stable disease (33%). Eight patients were alive more than I year after starting thalidomide, although almost all with tumor progression. Changes in serum levels of basic fibroblastic growth factor (bFGF) were correlated with time to tumor progression and overall survival. Conclusion: Thalidomide is a generally well-tolerated drug that may have antitumor activity in a minority of patients with recurrent high-grade gliomas. Future studies will better define the usefulness of thalidomide in newly diagnosed patients with malignant gliomas and in combination with radiotherapy and chemotherapy. Additionally, studies will be needed to confirm the potential utility of changes in serum bFGF as a marker of antiangiogenic activity and/or glioma growth. (C) 2000 American Society of Clinical Oncology.

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Fine HA, Figg WD, Jaeckle K, Wen PY, Kyritsis AP, Loeffler JS et al. Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas. Journal of Clinical Oncology. 2000 Feb 1;18(4):708-715.