ABSTRACT
BACKGROUND: We evaluated the efficacy of imatinib mesylate in addition to hydroxyurea in patients with recurrent glioblastoma (GBM) who were either on or not on enzyme-inducing anti-epileptic drugs (EIAEDs). METHODS: A total of 231 patients with GBM at first recurrence from 21 institutions in 10 countries were enrolled. All patients received 500 mg of hydroxyurea twice a day. Imatinib was administered at 600 mg per day for patients not on EIAEDs and at 500 mg twice a day if on EIAEDs. The primary end point was radiographic response rate and secondary end points were safety, progression-free survival at 6 months (PFS-6), and overall survival (OS). RESULTS: The radiographic response rate after centralised review was 3.4%. Progression-free survival at 6 months and median OS were 10.6% and 26.0 weeks, respectively. Outcome did not appear to differ based on EIAED status. The most common grade 3 or greater adverse events were fatigue (7%), neutropaenia (7%), and thrombocytopaenia (7%). CONCLUSIONS: Imatinib in addition to hydroxyurea was well tolerated among patients with recurrent GBM but did not show clinically meaningful anti-tumour activity.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brain Neoplasms/drug therapy , Glioblastoma/drug therapy , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adult , Aged , Benzamides , Biomarkers, Tumor/analysis , Female , Glioblastoma/mortality , Humans , Hydroxyurea/administration & dosage , Hydroxyurea/adverse effects , Hydroxyurea/pharmacokinetics , Imatinib Mesylate , Male , Middle Aged , Piperazines/administration & dosage , Piperazines/adverse effects , Piperazines/pharmacokinetics , Proto-Oncogene Proteins c-kit/genetics , Pyrimidines/administration & dosage , Pyrimidines/adverse effects , Pyrimidines/pharmacokinetics , Survival RateABSTRACT
BACKGROUND: Intradural extramedullary cysts are a rare cause of spinal cord compression. We present a case with slowly progressive radicular pain and gait disorder over several years, due to medullary compression by a giant cervico-thoracic arachnoid cyst. CASE REPORT: A 65-year-old man presented with progressive pain irradiating from the lower back to the waist and both legs over a period of 2 years. Neurological examination revealed a decreased sensation for pain, vibration, and proprioception below T7, without muscle weakness. Reflexes were increased in both lower extremities, with bilateral extensor plantar responses. The MRI showed an intradural extramedullary lesion, suggestive for an arachnoid cyst. The spinal cord was displaced and compressed anteriorly, with a smallest diameter of 1 mm. Surgical resection of the cyst resulted in decompression and re-expansion of the spinal cord as visualized with MRI. Neurological examination 6 months after surgery revealed nearly complete recovery of neurological deficits. DISCUSSION: This case report, together with a review of the literature, shows the extreme adaptability of the human spinal cord, in cases of slowly progressive compression.
