Journal of Clinical Oncology, Vol 15, 1063-1070, Copyright © 1997 by American Society of Clinical Oncology
TPDC-FuHu chemotherapy for the treatment of recurrent metastatic brain tumors
SE Kaba, AP Kyritsis, K Hess, WK Yung, R Mercier, S Dakhil, KA Jaeckle and VA Levin
Department of Neuro-Oncology and Biomathematics, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
PURPOSE: To evaluate a combination of thioguanine, procarbazine,
dibromodulcitol, CCNU (CCNU), fluorouracil, and hydroxyurea (TPDC- FuHu),
designed to improve the efficacy of CCNU, in the treatment of recurrent
metastatic brain tumors. PATIENTS AND METHODS: One hundred fifteen patients
with progressive or recurrent metastatic brain tumors that failed to
respond to surgery and/or radiation therapy were enrolled onto a
multicenter prospective study between 1989 and 1995. Patients received
TPDC-FuHu in a repeated cycle every 6 weeks until recurrence or until they
completed six courses. RESULTS: Ninety-seven patients were assessable at
the end of the study. Forty-eight had lung cancer (39 non-small-cell
[NSCLC] and nine small-cell [SCLC]), 28 had breast cancer, nine had
melanoma, and 12 had adenocarcinoma of different origins (three colon, two
kidney, one bladder, one stomach, and five of unknown origin). The response
and stable disease (SD) rate (overall response rate) was 52%, 66%, 60%, and
22% in patients with NSCLC, SCLC, breast cancer, and melanoma,
respectively. Median time to progression (MTP) was 12, 26, 12, and 6 weeks,
respectively, for the four groups. Side effects were mild to moderate in
the majority of patients. Severe myelosuppression (grade 4) occurred in
only 11% of the patients. CONCLUSION: TPDC-FuHu chemotherapy is an active
treatment against recurrent brain metastases from breast cancer and SCLC,
and to a lesser extent from NSCLC. This regimen is well tolerated and has
acceptable toxicity.
