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Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 1509
© 2005 American Society of Clinical Oncology
Prognostic factors for survival in adult patients with recurrent glioma enrolled on New Approaches to Brain Tumor Therapy (NABTT) CNS Consortium phase I and II clinical trials
K. Carson,
S. A. Grossman,
J. D. Fisher and
E. Shaw
Johns Hopkins Univ, Baltimore, MD; Wake Forest Univ, Winston-Salem, NC
1509
Background: Prognostic factor analyses have proven useful in predicting outcome in patients (pts) with newly diagnosed malignant glioma. Similar analysis should be of benefit in recurrent glioma. Methods: Between 1995 and 2002, 333 adult pts were enrolled on 10 phase I or II clinical trials of systemic or local chemotherapy or brachytherapy for the treatment of recurrent glioma. The studies had similar inclusion criteria and were conducted within the NABTT Consortium. Survival time was calculated from start of treatment until death or last follow-up. 308 (93%) pts have died. Univariate Cox proportional hazards (PH) regression analysis was performed to identify possible prognostic factors associated with an increased risk of death. Significant univariate predictors were included in multivariate analysis. Recursive partitioning analysis (RPA) was performed, and the log-rank test was used to group RPA classes with similar Kaplan-Meier survival estimates (KM). Results: Factors associated with an increased risk of death on univariate PH were increased age, lower KPS, initial and on-study histologies of GBM, steroid use, shorter time from original diagnosis to recurrence, and tumor location other than frontal. Factors that were not significant included gender, race, number of prior therapies, and anticonvulsant use. The final multivariate PH model included initial histology of GBM (relative risk (RR) = 2.04; 95% confidence interval (CI) = 1.49, 2.79), KPS < 90 (RR=1.35, 95% CI = 1.03, 1.77), 10 year increase in age (RR=1.20, 95% CI=1.06, 1.35), and steroid use (RR=1.56, 95% CI = 1.16, 2.10). RPA resulted in 5 classes, but 3 had similar KM and were combined. Median survival was poorest in GBM pts, age  50, on steroids (4.7 months (m); 95% CI=3.5, 5.3), best in pts with initial histology other than GBM and KPS 90 (20.2 m; 95% CI=12.2, 30.3), and was 7.4 m (95% CI=6.3, 9.0) for all other pts. Conclusions: Initial histology, KPS, age, and steroid use, are predictive of survival in recurrent glioma pts. Phase II and III clinical trials in pts with recurrent glioma should stratify by or adjust for these factors.
No significant financial relationships to disclose.
Abstract presentation from the 2005 ASCO Annual Meeting
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