Oral etoposide therapy for diffuse intrinsic brain stem glioma regrowth after local radiation therapy

Abstract

[Introduction] To date, few chemotherapeutic drugs have improved the survival rate of patients with diffuse intrinsic pontine glioma (DIPG). However, in some studies, metronomic chemotherapy with oral etoposide has been shown to improve the symptoms of patients with recurrent DIPG after radiotherapy, leading to a better quality of life.
[Methods] We reviewed the records of patients with DIPG, who were treated at our institution between April 2007 and January 2013, and verified the effectiveness of oral etoposide therapy in these patients.
[Results] One boy and 10 girls were included in this study. The median age at diagnosis was 5 years (range, 3–10 years). All the patients were diagnosed by magnetic resonance imaging except for one patient who underwent biopsy and was diagnosed as having glioblastoma. The median time from diagnosis to the administration of oral etoposide was 7 months (range, 2–10 months). Clinical improvement was seen in 8 of the 11 patients who had received treatment, whereas radiological improvement was observed in 3 of the 9 patients who underwent imaging studies. Among 8 patients taking steroids, 2 discontinued treatment, and another 2 had a dose reduction after starting oral etoposide. The median duration of oral etoposide administration was 6 months, with a maximum duration of 24 months. All adverse events were acceptable, except for severe myelosuppression in one patient who concomitantly received oral etoposide and whole spinal irradiation for spinal dissemination.
[Conclusion] We observed clear treatment benefits with oral etoposide therapy in some patients with recurrent DIPG. Therefore, we suggest that oral etoposide be considered as a form of palliative chemotherapy for these patients.