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Neoadjuvant chemotherapy with fluvastatin, carboplatin and vincristine for the treatment of low grade astrocytomas (LGA): a phase II study Pediatric study of low grade astrocytomas showed good response with the addition of fluvastatin to chemotherapy regimen of carboplatin and vincristine due to small sample size, more studies needed.

Posted on: 05/26/2002

Neoadjuvant chemotherapy with fluvastatin, carboplatin and vincristine for the treatment of low grade astrocytomas (LGA): a phase II study

Enrique Lopez Aguilar, Volkmar Wanzke-del Angel, Ana Carolina Sepulveda-Vildosola, Fernando Cerecedo-Diaz, Martha Valdez-Sanchez, Sandra Delgado-Huerta, Hospital de Pediatria, Centro Medico Nacional Siglo XXI IMSS, Mexico, DF, Mexico.

Two thirds of astrocytomas are classified as low grade. Those located on the brain stem are usually fatal in the short term and those in the thalamus and optic quiasm have a greater incidence of recurrence. The inhibitors of the biosynthesis of cholesterol have been previously used by the authors in LGA with apparent good response rate.

Objective: to determine the tumor response, survival and toxicity in pediatric patients with LGA in the thalamus, brain stem or optic quiasm treated with fluvastatin, carboplatin and vincristin.
Method: Patients with LGA located in the brain stem, thalamus or optic quiasm without prior treatment, with a residual tumor after surgery and who accepted to participate were included. They all received carboplatin (400 mg/m2 day 1), vincristine (2 mg/m2 day 1) and fluvastatin (10 mg/k/day from day 1-14)every 4 weeks for 4 courses. They all then underwent radiotherapy and 4 more courses of the above chemotherapeutic scheme. CT scans were realized after surgery and after the 2nd. and 4th. courses of chemotherapy.

Results: Eight patients were included, 5 in the brain stem and 3 in the thalamus. Four patients had pylocitic and 4 had fibrillar hystology. The mean age at diagnosis was 6.3 years. The mean residual tumor bulky after surgery was 39.3 cm2 and after the 4th course it reduced to 17 cm2 (45% reduction). The overall survival at 12 months is 60%. There was no significant toxicity in any of the 64 courses that have been administered.

Conclusions: these results suggest that there is a good response of these tumors to the chemotherapeutic regimen and we think that the addition of fluvastatin has been of benefit to the patients. Nevertheless, the sample size is small so it is necessary to include more patients and extend the follow-up period.
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