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Pemetrexed plus rituximab as second-line treatment for primary central nervous system lymphoma

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Abstract

The aim of the study was to determine the efficacy and toxicity of pemetrexed plus rituximab in patients with primary central nervous system lymphoma, who had undergone treatment with high-dose (HD) methotrexate-based regimens. Patients who had failed HD methotrexate-based regimens treatment had ECOG performance status ranging from 0 to 2. Twenty-seven patients received pemetrexed plus rituximab as second-line treatment. Rituximab 375 mg/m2 was administered on day 0 and pemetrexed 500 mg/m2 was administered on day 1 every 3 weeks. Six patients (22.2 %) experienced CR, 11 patients (40.7 %) had PR, eight patients (29.6 %) had SD, and two patients had PD. The response rate was 62.9 %. The median time to progression (PFS) was 6.9 months (95 % CI, 5.6–8.3), and the median overall survival was 11.2 months (95 % CI, 9.1–13.4). In the subgroup analysis, PFS had a significant difference among the low level of serum miR-21 and high level of serum miR-21. PFS was 9.0 (95 % CI, 6.3–11.6) and 5.7 months (95 % CI, 4.6–6.9, log rank = 0.015), respectively. None of the patient experienced grade 4 toxicity. A regimen of pemetrexed combined with rituximab is marginally effective and well tolerated in patients with PCNSL who had failed HD methotrexate-based regimens first-line treatment.

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References

  1. Abrey LE. Primary central nervous system lymphoma. Curr Opin Neurol. 2009;22:675–80.

    Article  PubMed  Google Scholar 

  2. Ferreri AJ, Reni M, Foppoli M, et al. High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomized phase 2 trial. Lancet. 2009;374:1512–20.

    Article  CAS  PubMed  Google Scholar 

  3. 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, noninferiority trial. Lancet Oncol. 2010;11:1036–47.

    Article  CAS  PubMed  Google Scholar 

  4. Jahnke K, Thiel E, Martus P, et al. Relapse of primary central nervous system lymphoma: clinical features, outcome and prognostic factors. J Neurooncol. 2006;80:159–65.

    Article  PubMed  Google Scholar 

  5. Ferreri AJ, Abrey LE, Blay JY, et al. Summary statement on primary central nervous system lymphomas from the Eighth International Conference on Malignant Lymphoma, Lugano, Switzerland, June 12 to 15, 2002. J Clin Oncol. 2003;21(12):2407–14.

    Article  PubMed  Google Scholar 

  6. Reni M, Mazza E, Foppoli M, Ferreri AJ. Primary central nervous system lymphomas: salvage treatment after failure to high-dose methotrexate. Cancer Lett. 2007;258(2):165–70.

    Article  CAS  PubMed  Google Scholar 

  7. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:235–42.

    Article  CAS  PubMed  Google Scholar 

  8. Mappa S, Marturano E, Licata G, et al. Salvage chemoimmunotherapy with rituximab, ifosfamide and etoposide (R-IE regimen) in patients with primary CNS lymphoma relapsed or refractory to high-dose methotrexate-based chemotherapy. Hematol Oncol. 2013;31(3):143–50.

    Article  CAS  PubMed  Google Scholar 

  9. Raizer JJ, Rademaker A, Evens AM, et al. Pemetrexed in the treatment of relapsed/refractory primary central nervous system lymphoma. Cancer. 2012;118:3743–8.

    Article  CAS  PubMed  Google Scholar 

  10. Wang Y, Wang X, Zhao Y, et al. Curative effect of pemetrexed on the treatment of relapsed primary central nervous system lymphoma. Zhonghua Xue Ye Xue Za Zhi. 2014;35(1):46–9.

    CAS  PubMed  Google Scholar 

  11. Reni M, Ferreri AJ, Villa E. Second-line treatment for primary central nervous system lymphoma. Br J Cancer. 1999;79:530–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Reni M, Zaja F, Mason W, et al. Temozolomide as salvage treatment in primary brain lymphomas. Br J Cancer. 2007;96:864–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Murakami M, Fujimaki T, Asano S, et al. Combination therapy with rituximab and temozolomide for recurrent and refractory primary central nervous system lymphoma. Yonsei Med J. 2011;52(6):1031–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Wong ET, Tishler R, Barron L, Wu JK. Immunochemotherapy with rituximab and temozolomide for central nervous system lymphomas. Cancer. 2004;101:139–45.

    Article  CAS  PubMed  Google Scholar 

  15. Zhang JP, Lee EQ, Nayak L, et al. Retrospective study of pemetrexed as salvage therapy for central nervous system lymphoma. J Neurooncol. 2013;115(1):71–7.

    Article  CAS  PubMed  Google Scholar 

  16. Wong SF, Gan HK, Cher L. A single centre study of the treatment of relapsed primary central nervous system lymphoma (PCNSL) with single agent temozolomide. J Clin Neurosci. 2012;19(11):1501–5.

    Article  CAS  PubMed  Google Scholar 

  17. Nayak L, Abrey LE, Drappatz J, et al. Multicenter phase II study of rituximab and temozolomide in recurrent primary central nervous system lymphoma. Leuk Lymphoma. 2013;54(1):58–61.

    Article  CAS  PubMed  Google Scholar 

  18. Birnbaum T, Stadler EA, von Baumgarten L, et al. Rituximab significantly improves complete response rate in patients with primary CNS lymphoma. J Neurooncol. 2012;109(2):285–91.

    Article  CAS  PubMed  Google Scholar 

  19. Teplyuk NM, Mollenhauer B, Gabriely G, et al. MicroRNAs in cerebrospinal fluid identify glioblastoma and metastatic brain cancers and reflect disease activity. Neuro Oncol. 2012;14(6):689–700.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Ma X, Yoshimoto K, Guan Y, et al. Associations between microRNA expression and mesenchymal marker gene expression in glioblastoma. Neuro Oncol. 2012;14(9):1153–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Shen J, Todd NW, Zhang H, et al. Plasma microRNAs as potential biomarkers for nonsmall-cell lung cancer. Lab Invest. 2011;91:579–87.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Lawrie CH, Gal S, Dunlop HM, et al. Detection of elevated levels of tumour-associated microRNAs in serum of patients with diffuse large B-cell lymphoma. Br J Haematol. 2008;141:672–5.

    Article  PubMed  Google Scholar 

  23. Mao X, Sun Y, Tang J. Serum miR-21 is a diagnostic and prognostic marker of primary central nervous system lymphoma. Neurol Sci. 2014;35(2):233–8.

    Article  PubMed  Google Scholar 

  24. Medina PP, Nolde M, Slack FJ. OncomiR addiction in an in vivo model of microRNA-21-induced pre-B-cell lymphoma. Nature. 2010;467:86–90.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Shan Dong Tumor Hospital, No. 440, Jiyan Jinan Road, Jinan, Shandong, 250117, People’s Republic of China

    Hai-Tao Zhao & Rong-Jie Tao

  2. Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, No. 105, Jiefang Road, Jinan, Shandong, 250013, People’s Republic of China

    Jing Chen

  3. Department of Oncology, Shan Dong Tumor Hospital, No. 440, Jiyan Jinan Road, Jinan, Shandong, 250117, People’s Republic of China

    Sheng-bin Shi & Jing Tian

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  1. Hai-Tao Zhao
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  2. Jing Chen
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  3. Sheng-bin Shi
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  4. Jing Tian
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  5. Rong-Jie Tao
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Correspondence to Rong-Jie Tao.

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Hai-Tao Zhao and Jing Chen have contributed equally to this work.

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Zhao, HT., Chen, J., Shi, Sb. et al. Pemetrexed plus rituximab as second-line treatment for primary central nervous system lymphoma. Med Oncol 32, 351 (2015). https://doi.org/10.1007/s12032-014-0351-7

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