Combination therapy of malignant glioma with intravenous methyl CCNU (I.V. MeCCNU), epipodophyllotoxin (PTG) and radiotherapy
IV MeCCNU and PGT are a promising combination in the treatment of malignant glioma because of their suggested individual activity and because of the marrow sparing characteristics of PTG. Following Folowing appropriate surgery, patients received IV MeCCNU (130-150 mg/m2 q. 6 wk), PTG (100 mg/m2 weekly x 6 wk), and radiotherapy (6,000 rad). 15 of 18 patients had at least 1 full course of therapy and are evaluable. Three patients deteriorated within 2 courses of therapy. 11 continued in a state of well being for 1+ to 10+ mth (median 5 mth), and 1 patient stabilized from progressive disease for 5 mth. Delayed cumulative bone marrow toxicity was profound with 10/17 patients having thrombocytopenia (<50,000) and/or leukopenia (<2,000) severe enough to require dosage reduction. Fever, persistent nausea, and perioral ulceration prompted cessation of PTG in 2 patients. Like other combinations tested against malignant glioma, MeCCNU and PTG have yet to demonstrate enhanced therapeutic efficacy.