Abstract Details

Title Methotrexate, Rituximab, Temozolomide (MRT) Induction Therapy for Elderly Patients with Primary Central Nervous System Lymphoma (PCNSL)

Topic Neuro-oncology

Presentation(s) S56 - (-)

Poster/Presentation
Number 003

Objective

Background Treatment of PCNSL in elderly patients has not been well established and management can be challenging due to limited tolerance of chemotherapy and worse disease prognosis.

Design/Methods From 2007-2012, 18 PCNSL patients age ? 60 years received MRT induction. Median age at diagnosis was 69 (60-83). Induction therapy consisted of high-dose MTX at 3.5-8 g/m2 (days 1, 15), RTX at 375 mg/m2 (days 3, 10, 17, 24) and TMZ at 150 mg/m2 (days 7-11) of each 28-day cycle. MTX was given every 2 weeks until complete response (CR), RTX weekly for a total of 6 doses, and TMZ monthly until CR. Monthly MRI was used to assess response. Consolidation included two additional MTX cycles, followed by monthly maintenance MTX with or without TMZ, or autologous stem cell transplantation.

Results CR was achieved in 14/18 (78%) patients at a median of 4 months. 3/18 patients achieved partial response (PR). One patient had early progressive disease (PD) and died 11 months after treatment onset. At a median follow-up of 15.5 months from treatment initiation, 10/18 patients remain in CR, 2/18 patients continue to receive induction MRT, 5/18 developed relapse or progressive disease. One patient in CR died from complications unrelated to PCNSL. Median PFS has not been reached. MRT induction was well tolerated; significant toxicities included reversible grade 3 transaminitis (3/18), reversible grade 1-2 serum creatinine elevation (6/18), and ? grade 3 hematologic toxicity (3/18).

Conclusions In elderly patients with newly diagnosed PCNSL, MRT induction is well tolerated and associated with a high response rate. Our experience suggests that this regimen is safe and effective in this patient population.

Authors/Disclosures
Deborah Forst, MD PRESENTER	Dr. Forst has stock in Eli Lilly. Dr. Forst has received research support from Conquer Cancer Foundation of the American Society of Clinical Oncology. Dr. Forst has received research support from Palliative Care Research Cooperative Group. Dr. Forst has received research support from American Cancer Society Institutional Research Grant.
Andrew Chi, MD	No disclosure on file
Jorg Dietrich, MD, PhD, FAAN	Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ono Therapeutics. Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Johnson & Johnson. Dr. Dietrich has received publishing royalties from a publication relating to health care.
Elizabeth R. Gerstner, MD	Dr. Gerstner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Midatech. Dr. Gerstner has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Gerstner Family Foundation. The institution of Dr. Gerstner has received research support from NCI.
	No disclosure on file
	No disclosure on file
Fred H. Hochberg, MD	No disclosure on file
Scott R. Plotkin, MD, PhD, FAAN (Mass General Cancer Center)	Dr. Plotkin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for NFlection Therapeutics. Dr. Plotkin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Akouos. Dr. Plotkin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SonALAsense. Dr. Plotkin has stock in NFlection Therapeutics. Dr. Plotkin has stock in NF2 Therapeutics. Dr. Plotkin has stock in SonALAsense. Dr. Plotkin has received research support from Children's Tumor Foundation. Dr. Plotkin has received research support from Department of Defense. Dr. Plotkin has received research support from National Institutes of Health. Dr. Plotkin has received intellectual property interests from a discovery or technology relating to health care.
Bruce S. Rubin, MD, FAAN (Design Neuroscience Center)	No disclosure on file
Tracy T. Batchelor, MD, MPH (Brigham and Women's Hospital)	Dr. Batchelor has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date, Inc. An immediate family member of Dr. Batchelor has received publishing royalties from a publication relating to health care. Dr. Batchelor has received publishing royalties from a publication relating to health care.

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