Eight‐drugs‐in‐one‐day chemotherapy in postirradiated adult patients with malignant gliomas

Fifteen patients, 12 with glioblastoma multiforme and 3 with anaplastic astrocytoma, were treated with “eight‐drugs‐in‐one‐day” chemotherapy methylprednisolone 300 mg/m², vincristine 1.5 mg/m² (maximum of 2 mg/cycle), CCNU 75 mg/m², procarbazine 75 mg/m², hydroxyurea 3,000 mg/m², cisplatin 90 mg/m², cytosine arabinoside 300 mg/m², and imidazole carboxamide 150 mg/m². All patients had prior brain irradiation but none had previous chemotherapy. The population included 10 patients with progressive disease after irradiation and 5 who presented within 2 months of completing radiation. Patients received an average of 5 monthly cycles of chemotherapy. Three patients achieved a complete and 2 a partial response (CR + PRrate was 33%). The median survival time was 46 weeks, Myelosuppression was the doselimiting toxicity. Leucocyte counts between 2.0‐4.5 × 10³/mm³ were observed in 40% of patients, between 1.0‐<2.0 × 10³/mm³ in 33%, and < 1.0 × 10³/mm³ in 7%. Platelet counts between 50‐130 × 10³/mm³ were observed in 27% of patients, and < 50 × 10³/mm³ in 33%. Six patients suffered infections, 4 had reversible renal toxicity, 2 developed paresthesias, and one a debilitating myopathy related to treatment with dexamethasone. Ototoxicity was seen in 3 patients. Two patients developed pulmonary emboli. Nine patients had nausea and vomiting, in one case associated with Candida esophagitis. One long‐term survivor developed necrosis of the corpus callosum and dementia. Four patients discontinued treatment after an average of 3.5 cycles because of toxicity. Although extremely toxic, this regimen has modest activity in previously irradiated adult patients with malignant glioma.