Neuro-oncology advances · 2026
Lomustine with or without procarbazine in recurrent glioblastoma-A propensity score matching analysis.
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Haedenkamp Tareq, Fischl Anna, Gerken Michael, Rothhammer-Hampl Tanja, Fassbender Amelie, Klein Verena, Liu Ilon, Layer Katharina, Suboh Amani, Luger Anna-Luisa, Mildenberger Iris, Weller Johannes, Kebir Sied, Schmidt Teresa, Zeyen Thomas, Glas Martin, Herrlinger Ulrich, Onken Julia, Platten Michael, Schmidt-Graf Friederike, Steinbach Joachim P, Linker Ralf, Riemenschneider Markus J, Proescholdt Martin, Maurer Julia, Bumes Elisabeth, Hau Peter
Аннотация
BACKGROUND: Despite recent advances, survival in patients with glioblastoma remains poor. Outside clinical trials, lomustine is commonly considered standard of care in recurrent disease. However, comparative data between lomustine and other chemotherapy regimens are limited.
METHODS: We performed a retrospective multicenter cohort study including patients from seven certified neuro-oncology centers in Germany to compare lomustine monotherapy with combination therapy using lomustine and procarbazine in first recurrence of glioblastoma. Propensity score matching was applied to obtain comparable groups based on sex, age, extent of resection at primary diagnosis, Karnofsky performance status at the start of recurrence therapy, and MGMT promoter methylation status. Post-recurrence survival (PRS) and progression-free survival (PFS) were analyzed using Kaplan-Meier estimation and multivariable Cox regression analysis.
RESULTS: Seventy-seven patients were matched in each treatment group. PRS was comparable, with a median of 11.6 months for lomustine monotherapy and 10.0 months for lomustine plus procarbazine (log-rank test, P = .120). Multivariable Cox regression showed no significant difference (HR 1.33, 95% CI, 0.93-1.90, P = .123). PFS was shorter in patients receiving combination therapy compared to monotherapy (3.7 vs. 5.1 months, log-rank test, P = .042). Multivariable Cox regression did not reveal significant differences (HR 1.31, 95% CI, 0.90-1.90, P = .166).
CONCLUSIONS: Our data indicates that potential additive toxicity by intensified combination chemotherapy should be avoided due to lack of efficacy compared to lomustine monotherapy.
METHODS: We performed a retrospective multicenter cohort study including patients from seven certified neuro-oncology centers in Germany to compare lomustine monotherapy with combination therapy using lomustine and procarbazine in first recurrence of glioblastoma. Propensity score matching was applied to obtain comparable groups based on sex, age, extent of resection at primary diagnosis, Karnofsky performance status at the start of recurrence therapy, and MGMT promoter methylation status. Post-recurrence survival (PRS) and progression-free survival (PFS) were analyzed using Kaplan-Meier estimation and multivariable Cox regression analysis.
RESULTS: Seventy-seven patients were matched in each treatment group. PRS was comparable, with a median of 11.6 months for lomustine monotherapy and 10.0 months for lomustine plus procarbazine (log-rank test, P = .120). Multivariable Cox regression showed no significant difference (HR 1.33, 95% CI, 0.93-1.90, P = .123). PFS was shorter in patients receiving combination therapy compared to monotherapy (3.7 vs. 5.1 months, log-rank test, P = .042). Multivariable Cox regression did not reveal significant differences (HR 1.31, 95% CI, 0.90-1.90, P = .166).
CONCLUSIONS: Our data indicates that potential additive toxicity by intensified combination chemotherapy should be avoided due to lack of efficacy compared to lomustine monotherapy.