No benefit with TMZ
DOSE 54 Gy
http://www.ncbi.nlm.nih.gov/pubmed/19647954 [data from TMH]
Despite a number of clinical trials having been conducted over the last several decades to improve results in patients with DIPGs, the outcome in these patients has been frustrating and has remained largely unchanged.
Numerous Phase I/II trials were conducted with altered RT fractionation schedules, concurrent chemoradiotherapy, radiation sensitizers, and systemic CT
In a series of radiation dose–escalation studies, doses from 64.8 to 78 Gy with hyperfractionated radiotherapy had shown increased toxicity without any survival benefit
A trial of concurrent carboplatin and etoposide at a dose of 70.2 Gy with hyperfractionated radiotherapy did not improve outcome over RT alone (2-year survival rate, 11%)
There was no benefit with the addition of a regimen of lomustine, vincristine, and prednisone
Other chemotherapeutic schedules, interferon, bradykinin, RMP-7, cyclosporine, and tamoxifen with or without RT also did not show any survival advantage
A randomized trial with concurrent chemotherapy and dose escalation also showed no significant benefit over conventional treatment (Pediatric Oncology Group 9239).
Broniscer et al. reported the results of a multi-institutional study examining the role of neoadjuvant irinotecan followed by RT and then TMZ. Median survival was only 12 months (1-year OS rate, 48%) with a high incidence of hematologic toxicities.
Cohen et al. have presented a summary of prospective data of 61 DIPG patients treated with concurrent TMZ and RT, followed by adjuvant TMZ. The 1-year OS rate was only 39%, and 61% of patients died within 12 months of diagnosis and 89% within 18 months. This trial also concluded that TMZ does not improve the outcome in children with DIPGs.
Another small study using a combination of TMZ and cis–retinoic acid with RT has also failed to show any meaningful impact .
Biological agents such as the anti-epidermal growth factor receptor agent Nimotuzumab have shown some promise in a preliminary phase II study, and the efficacy of Nimotuzumab requires further evaluation
20 U. Bode, M. Windelberg and M. Massimino et al., Phase III trial of nimotuzumab for the treatment of newly diagnosed diffuse intrinsic pontine gliomas in children and adolescents [Abstract], J Clin Oncol 26 (Suppl) (2008), p. 2058.(20).