Skip to main content
Top
Published in: Current Neurology and Neuroscience Reports 2/2016

01-02-2016 | Neuro-oncology (L. E. Abrey, Section Editor)

Nitrosoureas in the Management of Malignant Gliomas

Authors: Alba A. Brandes, Marco Bartolotti, Alicia Tosoni, Enrico Franceschi

Published in: Current Neurology and Neuroscience Reports | Issue 2/2016

Login to get access

Abstract

Nitrosoureas represent one of the most active classes of agents in the treatment of high-grade gliomas and glioblastoma. In clinical practice, the most commonly used compounds are lomustine (either alone or in combination with procarbazine and vincristine), carmustine, and fotemustine. Given their toxicity profile and subsequent to the introduction of temozolomide in clinical practice, most of these agents were moved to the recurrent setting. This review focuses on the role of the nitrosoureas currently used in clinical practice for the treatment of malignant gliomas.
Literature
1.
go back to reference DeVita VT, et al. Rosenberg, Steven A. Devita, Hellman, and Rosenberg’s cancer: principles & practice of oncology. Philadelphia: Wolters Kluwer. Second edition. Pp 372–373 DeVita VT, et al. Rosenberg, Steven A. Devita, Hellman, and Rosenberg’s cancer: principles & practice of oncology. Philadelphia: Wolters Kluwer. Second edition. Pp 372–373
2.•
go back to reference Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet. 2002;359(9311):1011–8. Meta-analysis showing the survival improvement obtained with nitrosoureas in newly-diagnosed high-grade gliomas.CrossRefPubMed Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet. 2002;359(9311):1011–8. Meta-analysis showing the survival improvement obtained with nitrosoureas in newly-diagnosed high-grade gliomas.CrossRefPubMed
3.•
go back to reference Walker MD et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med. 1980;303(23):1323–9. Randomized trial that showed the survival advantage of BCNU plus RT over RT alone in newly-diagnosed GBM.CrossRefPubMed Walker MD et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med. 1980;303(23):1323–9. Randomized trial that showed the survival advantage of BCNU plus RT over RT alone in newly-diagnosed GBM.CrossRefPubMed
4.
go back to reference Brandes AA et al. Early chemotherapy and concurrent radio-chemotherapy in high grade glioma. J Neurooncol. 1996;30(3):247–55.CrossRefPubMed Brandes AA et al. Early chemotherapy and concurrent radio-chemotherapy in high grade glioma. J Neurooncol. 1996;30(3):247–55.CrossRefPubMed
5.
go back to reference van den Bent MJ et al. Randomized phase II trial of erlotinib versus temozolomide or carmustine in recurrent glioblastoma: EORTC brain tumor group study 26034. J Clin Oncol. 2009;27(8):1268–74.PubMedCentralCrossRefPubMed van den Bent MJ et al. Randomized phase II trial of erlotinib versus temozolomide or carmustine in recurrent glioblastoma: EORTC brain tumor group study 26034. J Clin Oncol. 2009;27(8):1268–74.PubMedCentralCrossRefPubMed
6.
go back to reference Brandes AA et al. How effective is BCNU in recurrent glioblastoma in the modern era? A phase II trial. Neurology. 2004;63(7):1281–4.CrossRefPubMed Brandes AA et al. How effective is BCNU in recurrent glioblastoma in the modern era? A phase II trial. Neurology. 2004;63(7):1281–4.CrossRefPubMed
8.
go back to reference Brandes AA et al. Second-line chemotherapy with irinotecan plus carmustine in glioblastoma recurrent or progressive after first-line temozolomide chemotherapy: a phase II study of the Gruppo Italiano Cooperativo di Neuro-Oncologia (GICNO). J Clin Oncol. 2004;22(23):4779–86.CrossRefPubMed Brandes AA et al. Second-line chemotherapy with irinotecan plus carmustine in glioblastoma recurrent or progressive after first-line temozolomide chemotherapy: a phase II study of the Gruppo Italiano Cooperativo di Neuro-Oncologia (GICNO). J Clin Oncol. 2004;22(23):4779–86.CrossRefPubMed
9.
go back to reference Levin VA et al. Nitrosourea chemotherapy for primary malignant gliomas. Cancer Treat Rep. 1976;60:719–24.PubMed Levin VA et al. Nitrosourea chemotherapy for primary malignant gliomas. Cancer Treat Rep. 1976;60:719–24.PubMed
10.
go back to reference Shapiro WR et al. Chemotherapy of malignant glioma with CCNU alone and CCNU combined with vincristine sulfate and procarbazine hydrochloride. Trans Am Neurol Assoc. 1976;101:217–20.PubMed Shapiro WR et al. Chemotherapy of malignant glioma with CCNU alone and CCNU combined with vincristine sulfate and procarbazine hydrochloride. Trans Am Neurol Assoc. 1976;101:217–20.PubMed
11.
go back to reference E.O.R.T.C. Brain Tumor Group. Effect of CCNU on survival rate of objective remission and duration of free interval in patients with malignant brain glioma--final evaluation. Eur J Cancer. 1978;14(8):851–6.CrossRef E.O.R.T.C. Brain Tumor Group. Effect of CCNU on survival rate of objective remission and duration of free interval in patients with malignant brain glioma--final evaluation. Eur J Cancer. 1978;14(8):851–6.CrossRef
12.
go back to reference Eyre HJ et al. Randomized comparisons of radiotherapy and CCNU versus radiotherapy, CCNU plus procarbazine for the treatment of malignant gliomas following surgery. A Southwest Oncology Group Report. J Neurooncol. 1983;1(3):171–7.CrossRefPubMed Eyre HJ et al. Randomized comparisons of radiotherapy and CCNU versus radiotherapy, CCNU plus procarbazine for the treatment of malignant gliomas following surgery. A Southwest Oncology Group Report. J Neurooncol. 1983;1(3):171–7.CrossRefPubMed
13.
go back to reference Levin VA. Chemotherapy of primary brain tumors. In: Frank BD, editor. Symposium on Neuro-oncology, vol 3, Neurologic Clinics. 4th ed. York, Penn: WB Saunders; 1985. p. 855–66. Levin VA. Chemotherapy of primary brain tumors. In: Frank BD, editor. Symposium on Neuro-oncology, vol 3, Neurologic Clinics. 4th ed. York, Penn: WB Saunders; 1985. p. 855–66.
14.•
go back to reference 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. J Radiat Oncol Biol Phys. 1990;18:321–4. This study showed the survival advantage of PCV over BCNU as post-RT adjuvant therapy in high-grade gliomas.CrossRef 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. J Radiat Oncol Biol Phys. 1990;18:321–4. This study showed the survival advantage of PCV over BCNU as post-RT adjuvant therapy in high-grade gliomas.CrossRef
15.
go back to reference 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. J Radiat Oncol Biol Phys. 1990;18:321–4.CrossRef 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. J Radiat Oncol Biol Phys. 1990;18:321–4.CrossRef
16.
go back to reference Stupp R et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.CrossRefPubMed Stupp R et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.CrossRefPubMed
17.
go back to reference Wick W, Puduvalli VK, Chamberlain MC, et al. Phase III study of enzastaurin compared with lomustine in the treatment of recurrent intracranial glioblastoma. J Clin Oncol. 2010;28(7):1168–74.PubMedCentralCrossRefPubMed Wick W, Puduvalli VK, Chamberlain MC, et al. Phase III study of enzastaurin compared with lomustine in the treatment of recurrent intracranial glioblastoma. J Clin Oncol. 2010;28(7):1168–74.PubMedCentralCrossRefPubMed
18.
go back to reference Batchelor T et al. The efficacy of cediranib as monotherapy and in combination with lomustine compared to lomustine alone in patients with recurrent glioblastoma: a phase III randomized trial. J Clin Oncol. 2013;31:3212–8.PubMedCentralCrossRefPubMed Batchelor T et al. The efficacy of cediranib as monotherapy and in combination with lomustine compared to lomustine alone in patients with recurrent glioblastoma: a phase III randomized trial. J Clin Oncol. 2013;31:3212–8.PubMedCentralCrossRefPubMed
19.
go back to reference Taal W et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncol. 2014;15:943–53.CrossRefPubMed Taal W et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncol. 2014;15:943–53.CrossRefPubMed
20.•
go back to reference Brandes AA et al. Fotemustine as second-line treatment for recurrent or progressive glioblastoma after concomitant and/or adjuvant temozolomide: a phase II trial of Gruppo Italiano Cooperativo di Neuro-Oncologia (GICNO). Cancer Chemother Pharmacol. 2009;64(4):769–75. This study showed the activity of fotemustine in recurrent GBM.PubMedCentralCrossRefPubMed Brandes AA et al. Fotemustine as second-line treatment for recurrent or progressive glioblastoma after concomitant and/or adjuvant temozolomide: a phase II trial of Gruppo Italiano Cooperativo di Neuro-Oncologia (GICNO). Cancer Chemother Pharmacol. 2009;64(4):769–75. This study showed the activity of fotemustine in recurrent GBM.PubMedCentralCrossRefPubMed
21.
22.
go back to reference Brandes A et al. Randomized phase II trial AVAREG (ML25739) with bevacizumab (BEV) or fotemustine (FTM) in recurrent glioblastoma: final results from the randomized phase II trial. Ann Oncol. 2014;25 suppl 4:iv137. Brandes A et al. Randomized phase II trial AVAREG (ML25739) with bevacizumab (BEV) or fotemustine (FTM) in recurrent glioblastoma: final results from the randomized phase II trial. Ann Oncol. 2014;25 suppl 4:iv137.
23.
go back to reference Cairncross G et al. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol. 2006;24:2707–14.CrossRefPubMed Cairncross G et al. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol. 2006;24:2707–14.CrossRefPubMed
24.
go back to reference van den Bent MJ et al. Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: a randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol. 2006;24:2715–22.CrossRefPubMed van den Bent MJ et al. Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: a randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol. 2006;24:2715–22.CrossRefPubMed
25.•
go back to reference Wick W et al. NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol. 2009;27(35):5874–80. A randomized phase III trial that compares upfront treatment with RT or chemotherapy (PCV or temozolomide) in anaplastic gliomas.CrossRefPubMed Wick W et al. NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol. 2009;27(35):5874–80. A randomized phase III trial that compares upfront treatment with RT or chemotherapy (PCV or temozolomide) in anaplastic gliomas.CrossRefPubMed
26.•
go back to reference Cairncross G et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2013;31(3):337–43. A randomized phase III trial that compared RT alone versus RT plus PCV as adjuvant treatment for AOD and AOA.PubMedCentralCrossRefPubMed Cairncross G et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2013;31(3):337–43. A randomized phase III trial that compared RT alone versus RT plus PCV as adjuvant treatment for AOD and AOA.PubMedCentralCrossRefPubMed
27.••
go back to reference van den Bent MJ et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol. 2013;31(3):344–50. This study showed an advantage in OS with the addition of PCV to standard radiotherapy in AO and AOA.CrossRefPubMed van den Bent MJ et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol. 2013;31(3):344–50. This study showed an advantage in OS with the addition of PCV to standard radiotherapy in AO and AOA.CrossRefPubMed
28.
go back to reference van den Bent MJ et al. MGMT promoter methylation is prognostic but not predictive for outcome to adjuvant PCV chemotherapy in anaplastic oligodendroglial tumors: a report from EORTC Brain Tumor Group Study 26951. J Clin Oncol. 2009;27(35):5881–6.PubMedCentralCrossRefPubMed van den Bent MJ et al. MGMT promoter methylation is prognostic but not predictive for outcome to adjuvant PCV chemotherapy in anaplastic oligodendroglial tumors: a report from EORTC Brain Tumor Group Study 26951. J Clin Oncol. 2009;27(35):5881–6.PubMedCentralCrossRefPubMed
29.
go back to reference van den Bent MJ et al. IDH1 and IDH2 mutations are prognostic but not predictive for outcome in anaplastic oligodendroglial tumors: a report of the European Organization for Research and Treatment of Cancer Brain Tumor Group. Clin Cancer Res. 2010;16(5):1597–604.CrossRefPubMed van den Bent MJ et al. IDH1 and IDH2 mutations are prognostic but not predictive for outcome in anaplastic oligodendroglial tumors: a report of the European Organization for Research and Treatment of Cancer Brain Tumor Group. Clin Cancer Res. 2010;16(5):1597–604.CrossRefPubMed
30.
go back to reference Wick W, et al. Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide. J Clin Oncol. 2015;33(suppl; abstr 2001) Wick W, et al. Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide. J Clin Oncol. 2015;33(suppl; abstr 2001)
31.
go back to reference Cairncross G et al. Chemotherapy for anaplastic oligodendroglioma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1994;12:2013–21.PubMed Cairncross G et al. Chemotherapy for anaplastic oligodendroglioma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1994;12:2013–21.PubMed
32.
go back to reference van den Bent MJ et al. Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-Oncol Group Neurol. 1998;51:1140–5. van den Bent MJ et al. Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-Oncol Group Neurol. 1998;51:1140–5.
33.•
go back to reference Brada M et al. Temozolomide versus procarbazine, lomustine, and vincristine in recurrent high-grade glioma. J Clin Oncol. 2010;28(30):4601–8. A trial comparing temozolomide versus PCV in recurrent high-grade gliomas.CrossRefPubMed Brada M et al. Temozolomide versus procarbazine, lomustine, and vincristine in recurrent high-grade glioma. J Clin Oncol. 2010;28(30):4601–8. A trial comparing temozolomide versus PCV in recurrent high-grade gliomas.CrossRefPubMed
34.
go back to reference Fernández-Hidalgo OA et al. High-dose BCNU and autologous progenitor cell transplantation given with intra-arterial cisplatinum and simultaneous radiotherapy in the treatment of high-grade gliomas: benefit for selected patients. Bone Marrow Transplant. 1996;18(1):143–9.PubMed Fernández-Hidalgo OA et al. High-dose BCNU and autologous progenitor cell transplantation given with intra-arterial cisplatinum and simultaneous radiotherapy in the treatment of high-grade gliomas: benefit for selected patients. Bone Marrow Transplant. 1996;18(1):143–9.PubMed
35.
go back to reference Jakacki RI et al. Dose-intensive, time-compressed procarbazine, CCNU, vincristine (PCV) with peripheral blood stem cell support and concurrent radiation in patients with newly diagnosed high-grade gliomas. J Neurooncol. 1999;44(1):77–83.CrossRefPubMed Jakacki RI et al. Dose-intensive, time-compressed procarbazine, CCNU, vincristine (PCV) with peripheral blood stem cell support and concurrent radiation in patients with newly diagnosed high-grade gliomas. J Neurooncol. 1999;44(1):77–83.CrossRefPubMed
Metadata
Title
Nitrosoureas in the Management of Malignant Gliomas
Authors
Alba A. Brandes
Marco Bartolotti
Alicia Tosoni
Enrico Franceschi
Publication date
01-02-2016
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 2/2016
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-015-0611-8

Other articles of this Issue 2/2016

Current Neurology and Neuroscience Reports 2/2016 Go to the issue

Neurology of Systemic Diseases (J Biller, Section Editor)

Neurocutaneous Disorders for the Practicing Neurologist: a Focused Review

Infection (J Halperin, Section Editor)

Developments in Varicella Zoster Virus Vasculopathy

Headache (R. B. Halker, Section Editor)

Non-Invasive Neuromodulation for Headache Disorders