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FET-PET-based reirradiation and chloroquine in patients with recurrent glioblastoma

First tolerability and feasibility results

FET-PET-basierte Rebestrahlung und Chloroquin bei Patienten mit rezidiviertem Glioblastom

Erste Ergebnisse zu Toleranz und Durchführbarkeit

  • Case study
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

Treatment of recurrent glioblastoma (rGBM) remains an unsolved clinical problem. Reirradiation (re-RT) can be used to treat some patients with rGBM, but as a monotherapy it has only limited efficacy. Chloroquine (CQ) is an anti-malaria and immunomodulatory drug that may inhibit autophagy and increase the radiosensitivity of GBM.

Patients and methods

Between January 2012 and August 2013, we treated five patients with histologically confirmed rGBM with re-RT and 250 mg CQ daily.

Results

Treatment was very well tolerated; no CQ-related toxicity was observed. At the first follow-up 2 months after finishing re-RT, two patients achieved partial response (PR), one patient stable disease (SD), and one patient progressive disease (PD). One patient with reirradiated surgical cavity did not show any sign of PD.

Conclusion

In this case series, we observed encouraging responses to CQ and re-RT. We plan to conduct a CQ dose escalation study combined with re-RT.

Zusammenfassung

Hintergrund

Die Behandlung rezidivierter Glioblastome (rGBM) ist problematisch. Manche Patienten können erneut bestrahlt (re-RT) werden, jedoch nur mit begrenzter Wirksamkeit. Das Antimalariamittel Chloroquin (CQ) wirkt immunmodulatorisch, hemmt die Autophagie und kann die Radiosensibilität erhöhen.

Ergebnisse

Zwischen Januar 2012 und August 2013 wurden 5 Patienten mit einem histologisch gesicherten rGBM mit re-RT und zusätzlich täglich 250 mg CQ behandelt. Diese Behandlung wurde sehr gut, ohne CQ-assoziierte Nebenwirkungen toleriert. Zum ersten Follow-up, 2 Monate nach der re-RT, fanden sich zwei partielle Remissionen (PR), ein stabiler Verlauf (SD) und ein Progress (PD). Ein zuvor operierter Patient war in anhaltender Remission.

Schlussfolgerung

Diese Fallstudie zeigt ein ermutigendes Ansprechen von Patienten mit rGBM auf eine Behandlung mit CQ und re-RT. Eine Dosiseskalationsstudie CQ/re-RT ist geplant.

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Fig. 1

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Acknowledgments

This work was supported by the German Consortium for Translational Cancer Research (Deutsches Konsortium für Translationale Krebsforschung, DKTK).

Compliance with ethical guidelines

Conflict of interest

A. Bilger, M.-I. Bittner, A.-L. Grosu, N. Wiedenmann, P.T. Meyer, E. Firat, G. Niedermann, W.A. Weber, and D. Milanović state that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Strasse 3, 79106, Freiburg, Germany

    Angelika Bilger, Martin-Immanuel Bittner, Anca-L. Grosu, Nicole Wiedenmann, Elke Firat, Gabriele Niedermann &  Dušan Milanović

  2. Department of Nuclear Medicine, University Medical Center Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany

    Philipp T. Meyer & Wolfgang A. Weber

  3. Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, 127510065, York Avenue, NY, USA

    Wolfgang A. Weber

Authors
  1. Angelika Bilger
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  2. Martin-Immanuel Bittner
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  3. Anca-L. Grosu
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  4. Nicole Wiedenmann
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  5. Philipp T. Meyer
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  6. Elke Firat
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  7. Gabriele Niedermann
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  8. Wolfgang A. Weber
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  9. Dušan Milanović
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Corresponding author

Correspondence to Dušan Milanović.

Additional information

Angelika Bilger and Martin-Immanuel Bittner contributed equally to this work.

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Bilger, A., Bittner, MI., Grosu, AL. et al. FET-PET-based reirradiation and chloroquine in patients with recurrent glioblastoma. Strahlenther Onkol 190, 957–961 (2014). https://doi.org/10.1007/s00066-014-0693-2

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  • DOI: https://doi.org/10.1007/s00066-014-0693-2

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