PNV-chemotherapy (procarbazine, nimustine, vincristine) in the treatment of patients with high grade glioma

Introduction: PCV-chemotherapy (procarbazine, lomustine, vincristine) is one of the standard post-surgical and post-radiation therapeutic regimens in patients with anaplastic astrocytoma as shown by Levin and co-authors in 1990. However the role of chemotherapy in patients with glioblastoma remains unclear. Methods: Between April 1995 and June 1996 26 patients with supratentorial high grade glioma (12 - anaplastic astrocitoma (AA) and 14 - glioblastoma multiforme (GBM)) were included into our study for evaluating the feasibility, response and toxicity of adjuvant post-radiation chemotherapy with PNV-combination (60 mg/m2 of procarbazine days 1-14, 2.5 mg/kg nimustine iv day 1, 1.4 mg/m2 vincristine days 1.8, each cycle of PNV repeated every 6 weeks). Before chemotherapy all patients were operated in our clinic and after the operation they received radiation therapy to a total dose of 6000 cGr which was administrated in 30-35 fractions over 6-7 weeks. Chemotherapy was started within 2-4 weeks after radiation therapy. Results: The PNV-regimen was well tolerated. The median time to tumour progression now (the 1st of November 1996) is 35 weeks. Eleven patients are alive at 12 months (8 AA, 3 GBM). 12 patients had grade II-III haematological toxicity, 2 patients had fllebitis of peripheral veins. 8 patients are still treated with PNV now. Conclusion: Our data suggest that PNV-chemotherapy could be used as adjuvant regimen in the treatment of patients with high grade glioma.