Anaplastic astrocytoma

Temozolomide (Temodar ) DNA-interactive Refractory anaplastic astrocytoma Phase II data... 

Liposomal doxorubicin also received initial approval on the basis of response rafe in patients with refractory cancer followed up with a randomized trial of the agent vs. topotecan. The alkylating agent temozolomide was approved in a Phase 11 trial for treatment of patients with anaplastic astrocytoma. Of note is that, although not yet filed for full approval, temozolomide has been recently added on to radiation therapy (e.g., a major trial of radiation therapy with or without temozolomide) for patients with glioblastoma multiforme. The result of this trial showed a major improvement in survival for patients treated with the radiation plus temozolomide vs. those treated with radiation therapy alone (median survival 15 vs. 12 months, p < 0.0001 and 1 year survival 26 vs. 8%, p < 0.0001).25... 

RT-PCR for CYP1A2 is negative in a series of 22 human glioblastomas and 4 anaplastic astrocytomas (Kirches et al., 1999). 

Prados MD, Scott C, Curran WJ, et al. Procarbazine, lomustine and vincristine (PCV) chemotherapy for anaplastic astrocytoma a retrospective review of Radiation Therapy Oncology Group Protocols comparing survival with carmustine or PCV adjuvant chemotherapy. J Clin Oncol 1999 17 3389-3395. 

Prados MD, Gutin PH, Phillips TL, et al. Highly anaplastic astrocytoma a review of 357 patients treated between 1977 and 1989. Int J Oncol Biol Phys 1992 23 3-8. 

Donahue B, Scott CB, Nelson JS, et al. Influence of an oligodendroglial component on the survival of patients with anaplastic astrocytomas A report of Radiation Therapy Oncology Group 83-02. Int J Radiat Oncol Biol Phys 1997 38 911-914. 

Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Oncol Biol Phys 1989 16 1405. 

Prados MD, Scott C, Sandler H, et al. A phase 3 randomized study of radiotherapy plus procarbazine, CCNU, and vincristine (PCV) with or without BUdR for the treatment of anaplastic astrocytoma a preliminary report of RTOG 9404. Int JRadiat Oncol Biol Phys 1999 45 1109-1115. 

Temozolomide is an imidazotetrazine derivative of the alkylating agent dacarbazine. It is an oral alkylating agent used for the treatment of refractory anaplastic astrocytoma. Apart from myelosuppression the most common adverse effects are nausea and vomiting. 

Lamer, J., Jane, J., Laws, E., Packer, R., Myers, C., and Shaffrey, M. (1998). A phase I-II trial of lovastatin for anaplastic astrocytoma and glioblastoma multiforme. Am J Clin Oncol 21 579-583. 

Brain lesion analysis is also an active area of research. DTI metrics have been found to help differentiate between tumor types and promises to provide a sensitive method for abnormal tissue characterization. Fractional anisotropy has already been found to correlate with the cell density of brain tumors (Beppu et al., 2003 Beppu et al., 2005). The ability of FA to correlate with cell density likely accounts for the sensitivity of FA to tissue typing in brain lesions. Fractional anisotropy has been found to differentiate between low grade and anaplastic astrocytomas, to help differentiate between brain metastasis and high grade gliomas, and there is evidence that FA may help to detect tumor infiltration not visible by conventional MRI (Holmes et al., 2004 Tsuchiya et al., 2005 Goebell et al., 2006). Other DTI metrics have been utilized in brain lesion analysis and the early findings point to the breadth of future possibilities. 

Prados MD, Seiferheld W, Sandler HM, Buckner JC, Phillips T, Schultz C, Urtasun R, Davis R, Gutin P, Cascino TL, Greenberg HS, Curran WJ Jr. Phase III randomized study of radiotherapy plus procarbazine, lomustine, and vincristine with or without BUdR for treatment of anaplastic astrocytoma final report of RTOG 9404. Int J Radiat Oncol Biol Phys 2004 58(4) 1147-52. 

Temozolomide-related myelodysplastic syndrome has been reported in a 44-year-old woman with recurrent anaplastic astrocytoma in association with a cytogenetic deletion in chromosome 3 (1). 

Trade name Temodar (Schering) Indications Anaplastic astrocytoma Category Alkylating agent Antineoplastic Half-life 1.8 hours... 

Anaplastic astrocytoma Increase in above features mitoses GFAP (S) S-100 Cerebrum brainstem CNS... 

Criteria for anaplastic oligodendroglioma are different than for anaplastic astrocytoma. An occasional mitosis and limited vascular proliferation may be found in a grade II oligodendroglioma. 

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