Pegylated Liposomal Doxorubicin in Recurrent Malignant Glioma: Analysis of a Case Series

BACKGROUND: Recurrent malignant glioma has a dismal prognosis, and therapeutic options are scarce. After previous potentially encouraging reports on liposomal pegylated doxorubicin (PEG-DOX) in this setting, PEG-DOX was applied to patients with recurrent malignant glioma in an institutional series. METHODS: In a retrospective analysis, 49 patients with recurrent high-grade glioma (WHO III, n = 18; WHO IV, n = 31) were treated with PEG-DOX (days 1 and 14/28, 20 mg/m(2), n = 26) alone or in combination with temozolomide (days 1-5/28, 200 mg/m(2), n = 23). The response rate, progression-free survival and overall survival were evaluated. RESULTS: The rate of progression-free patients at 6 months after initiation of therapy was 27% (WHO III, 33%; WHO IV, 23%). The median overall survival (mOS) after initiation of PEG-DOX (monotherapy and combination therapy) was 8 months (WHO III, 16 months; WHO IV, 7 months). The mOS after initiation of PEG-DOX monotherapy was 8 months, and after initiation of combination therapy, 10 months. Both regimens were well tolerated, with the main side effect being hematologic toxicity (grade 1-2, 8%; grade 3-4, 18%). CONCLUSION: These data demonstrate the safety and moderate efficacy of PEG-DOX +/- temozolomide therapy in recurrent malignant glioma. The potential of this nonalkylating chemotherapy should be further explored.