Fotemustine, Teniposide and Dexamethasone in Treating Patients with CNS Lymphoma

Purpose: We developed and evaluated a regimen including fotemustine, teniposide and dexamethasone (FTD)for treating patients with central nervous system (CNS) lymphoma based on pharmacokinetic properties ofindividual agents and in combination. Patients and
Methods: In a comparison study, 8 patients with primaryCNS lymphoma (PCNSL) and 8 with secondary CNS lymphoma (SCNSL) were treated with FTD (comprisingfotemustine 100 mg/m2, 1h infusion, day 1; teniposide 60 mg/m2, >0.5 h infusion, on day 2, 3, 4; dexamethasone 40mg, 1h infusion, on day 1, 2, 3, 4 and 5; and methotrexate 12 mg, cytosine arabinoside 50 mg plus dexamethasone5 mg intrathecally, on day 2 and 7). Cycles were repeated every 3 weeks. After response assessment, patientsreceived whole brain radiotherapy.
Results: Of the 8 PCNSL patients, 4 (50%) achieved CR and 3 (38%) PR, anoverall response rate of 88%. Four patients (50%) were in continuing remission at the end of this study after amedian follow-up of 30 months (range 10 to 56 months). Of the 8 SCNSL patients the overall response rate was63% (CR+PR: 38%+25%). All responses were achievable with predictable toxicity mainly reflecting reversiblemyelosuppression.
Conclusion: This study suggests that FTD could be an effective treatment for CNS lymphoma,and is worthy of further evaluation.