Patterns of Treatment Failure in Primary Central Nervous System Lymphoma.
Journal
American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754
Informations de publication
Date de publication:
10 Apr 2024
10 Apr 2024
Historique:
medline:
22
5
2024
pubmed:
22
5
2024
entrez:
22
5
2024
Statut:
aheadofprint
Résumé
Progression of PCNSL remains a challenge with salvage therapies, including the risk of substantial morbidity and mortality. We report patterns of first tumor progression to inform opportunities for improvement. This is an institutional retrospective review from 2002 to 2021 of 95 consecutive patients with pathologically confirmed PCNSL, of whom 29 experienced progressive disease. Kaplan-Meier method, log-rank test, and Cox proportional hazard models are used to characterize associations of patient, tumor, and treatment variables with LC, PFS, and patterns of first failure. Most patients were below 65 years old (62%) with KPS >70 (64%) and negative CSF cytology (70%). In 70 patients with MRIs, the median tumor volume was 12.6 mL (range: 0.5 to 67.8 mL). After a median follow-up of 11 months, 1-year PFS was 48% and 1-year LC was 80%. Of the 29 patients with progression, 24% were distant only, 17% were distant and local, and 59% were local only. On MVA, LC was associated with age (HR: 1.08/y, P=0.02), KPS (HR: 0.10, P=0.02), completion of >6 cycles of HD-MTX (HR: 0.10, P<0.01), and use of intrathecal chemotherapy (HR: 0.03, P<0.01). On UVA, local only first failure trended to be increased with >14 mL tumors (OR: 5.06, P=0.08) with 1-year LC 83% (<14 mL) versus 64% (>14mL). There were no significant associations with LC and WBRT (P=0.37), Rituximab (P=0.12), or attempted gross total resection (P=0.72). Our findings reaffirm the importance of systemic and intrathecal therapies for local control in PCNSL. However, bulky tumors trend to fail locally, warranting further investigation about the role of local therapies or systemic therapy intensification.
Identifiants
pubmed: 38775180
doi: 10.1097/COC.0000000000001093
pii: 00000421-990000000-00196
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Mendez JS, Ostrom QT, Gittleman H, et al. The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades. Neuro Oncol. 2018;20:687–694.
Grommes C, Rubenstein JL, DeAngelis LM, et al. Comprehensive approach to diagnosis and treatment of newly diagnosed primary CNS lymphoma. Neuro Oncol. 2019;21:296–305.
Bataille B, Delwail V, Menet E, et al. Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg. 2000;92:261–266.
Ferreri AJ, Blay JY, Reni M, et al. Prognostic scoring system for primary CNS lymphomas: The International Extranodal Lymphoma Study Group experience. J Clin Oncol. 2003;21:266–272.
Abrey LE, Ben-Porat L, Panageas KS, et al. Primary central nervous system lymphoma: the memorial sloan-kettering cancer center prognostic model. J Clin Oncol. 2006;24:5711–5715.
Jahr G, Broi MD, Holte H Jr, et al. Evaluation of Memorial Sloan-Kettering Cancer Center and International Extranodal Lymphoma Study Group prognostic scoring systems to predict overall survival in intracranial primary CNS lymphoma. Brain Behav. 2018;8:1–8.
Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of hodgkin and non-hodgkin lymphoma: The Lugano Classification. J Clin Oncol. 2014;32:3059–3068.
Vercellino L, Di Blasi R, Kanoun S, et al. Predictive factors of early progression after CAR T-cell therapy in relapsed/refractory diffuse large B-cell lymphoma. Blood Adv. 2020;4:5607–5615.
Persky DO, Unger JM, Spier CM, et al. Phase II study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma: Southwest Oncology Group study 0014. J Clin Oncol. 2008;26:2258–2263.
Pfreundschuh M, Murawski N, Ziepert M, et al. Radiotherapy (RT) to bulky (B) and extralymphatic (E) disease in combination with 6xR-CHOP-14 or R-CHOP-21 in young good-prognosis DLBCL patients: results of the 2×2 randomized UNFOLDER trial of the DSHNHL/GLA. J Clin Oncol. 2018;36:7574.
Burt Nabors L, Portnow J, Baehring J, et al. NCCN Guidelines Version 2.2021 Central Nervous System Cancers Continue NCCN Guidelines Panel Disclosures. 2021.
Thiel E, Korfel A, Martus P, et al. High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol. 2010;11:1036–1047.
DeAngelis LM, Seiferheld W, Schold SC, et al. Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group study 93-10. J Clin Oncol. 2002;20:4643–4648.
Poortmans PM, Kluin-Nelemans HC, Haaxma-Reiche H, et al. High-dose methotrexate-based chemotherapy followed by consolidating radiotherapy in non-AIDS-related primary central nervous system lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase II Trial 20962. J Clin Oncol. 2003;21:4483–4488.
Pulczynski EJ, Kuittinen O, Erlanson M, et al. Successful change of treatment strategy in elderly patients with primary central nervous system lymphoma by de-escalating induction and introducing temozolomide maintenance: results from a phase II study by the Nordic Lymphoma Group. Haematologica. 2015;100:534–540.
Ferreri AJM, Cwynarski K, Pulczynski E, et al. Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal L. Lancet Haematol. 2017;4:e510–e523.
Ferreri AJ, Cwynarski K, Pulczynski E, et al. Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol. 2016;3:217–227.
Holdhoff M, Mrugala MM, Grommes C, et al. Challenges in the treatment of newly diagnosed and recurrent primary central nervous system lymphoma. JNCCN J Natl Compr Canc Netw. 2020;18:1571–1578.
Ramadan S, Radice T, Ismail A, et al. Advances in therapeutic strategies for primary CNS B-cell lymphomas. Expert Rev Hematol. 2022;15:295–304.
Wen PY, Chang SM, Van den Bent MJ, et al. Response assessment in neuro-oncology clinical trials. J Clin Oncol. 2017;35:2439–2449.
Liu Y, Nickleach DC, Zhang C, et al. Carrying out streamlined routine data analyses with reports for observational studies: introduction to a series of generic SAS ®macros. F1000Research. 2019;7:1–21.
de Pádua Covas Lage LA, Araújo Soares V, Meneguin TD, et al. The role of whole-brain radiotherapy (WBRT) in primary central nervous system lymphoma: is it an alternative to ASCT for consolidation following HD-methotrexate based induction in low-income settings? Radiat Oncol. 2022;17:1–12.
Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295:2483–2491.
Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10:1037–1044.
Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011;29:134–141.
Patil CG, Pricola K, Sarmiento JM, et al. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev. 2017;9:174–181.
Lamy T, Damaj G, Soubeyran P, et al. R-CHOP 14 with or without radiotherapy in nonbulky limited-stage diffuse large B-cell lymphoma. Blood. 2018;131:174–181.
Langner-Lemercier S, Houillier C, Soussain C, et al. Primary CNS lymphoma at first relapse/progression: characteristics, management, and outcome of 256 patients from the French LOC network. Neuro Oncol. 2016;18:1297–1303.
Alvarez-Pinzon AM, Wolf AL, Swedberg H, et al. Primary central nervous system lymphoma (PCNSL): analysis of treatment by gamma knife radiosurgery and chemotherapy in a prospective, observational study. Cureus. 2016;8:1–9.
Trifiletti DM, Lee CC, Kano H, et al. Stereotactic radiosurgery for brainstem metastases: an international cooperative study to define response and toxicity. Int J Radiat Oncol Biol Phys. 2016;96:280–288.
Shibamoto Y, Hayabuchi N, Hiratsuka J, et al. Is whole-brain irradiation necessary for primary central nervous system lymphoma? Patterns of recurrence after partial-brain irradiation. Cancer. 2003;97:128–133.
Brown PD, Asher AL, Ballman KV, et al. NCCTG N0574 (Alliance): a phase III randomized trial of whole brain radiation therapy (WBRT) in addition to radiosurgery (SRS) in patients with 1 to 3 brain metastases. J Clin Oncol. 2015;33:LBA4.
Bellinzona M, Roser F, Ostertag H, et al. Surgical removal of primary central nervous system lymphomas (PCNSL) presenting as space occupying lesions: a series of 33 cases. Eur J Surg Oncol. 2005;31:100–105.
Weller M, Martus P, Roth P, et al. Surgery for primary CNS lymphoma? Challenging a paradigm. Neuro Oncol. 2012;14:1481–1484.
Rae AI, Mehta A, Cloney M, et al. Craniotomy and survival for primary central nervous system lymphoma. Neurosurgery. 2019;84:935–944.
Janopaul-Naylor JR, Shen Y, Qian DC, et al. The abscopal effect: a review of pre-clinical and clinical advances. Int J Mol Sci. 2021;22:1–16.
Ibrutinib with rituximab and lenalidomide for patients with recurrent/refractory primary or secondary central nervous system lymphoma (PCNSL/SCNSL). Accessed May 10, 2023. 2023. https://clinicaltrials.gov/study/NCT03703167?cond=Primary%20CNS%20Lymphoma%20%5C(PCNSL%5C)&intr=Lenalidomide&rank=3
A phase I/II study to investigate the use of VORAXAZE as intended intervention in patients with CNSL (VALIDATE). Accessed May 10, 2023. https://clinicaltrials.gov/study/NCT04841434?cond=Primary%20CNS%20Lymphoma%20%5C(PCNSL%5C)&intr=glucarpidase&rank=2
Pembrolizumab, Ibrutinib and Rituximab in PCNSL. Accessed May 10, 2023. https://clinicaltrials.gov/study/NCT04421560?cond=Primary%20CNS%20Lymphoma%20%5C(PCNSL%5C)&intr=pembrolizumab%20ibrutinib%20rituximab&rank=1
16pt?> Study on pembrolizumab for recurrent primary central nervous system lymphoma (PCNSL)—full text view—ClinicalTrials.gov. Accessed May 2023. https://www.clinicaltrials.gov/study/NCT02779101
Qian DC, Kleber T, Brammer B, et al. Effect of immunotherapy time-of-day infusion on overall survival among patients with advanced melanoma in the USA (MEMOIR): a propensity score-matched analysis of a single-centre, longitudinal study. Lancet Oncol. 2021;22:1777–1786.