TreatmentUpdate84 - Vol. 9, No. 10 - pp. 5-6; December, 1997
Sean Hosein

In addition to being at increased risk for certain life-threatening infections, people with HIV/AIDS can get cancer of the brain. One form of brain cancer is called PCNSL--primary central nervous system lymphoma. The standard treatment is to beam radiation at the entire brain. This reduces the size of the tumour(s), but does not appear to have a major impact on survival. Moreover, this type of therapy reduces a person's ability to think. Alternatives are being tested in non-HIV-infected people with PCNSL. One treatment that appears promising uses the drug methotrexate. In a study with 15 PHAs, intravenous methotrexate seemed to bring about a nearly 50% recovery rate and prolonged survival.

Study Details

Over a period of 2 years, doctors in a clinic in France diagnosed PCNSL in 15 of 349 people with AIDS. Doctors were able to confirm the diagnosis by examining tumour samples in 10 cases (group 1). The 5 remaining cases comprised group 2. At the time of diagnosis, the groups' average CD4+ cell count was about 23 cells. Nurses gave subjects intravenous methotrexate at a dose of 3 g/square metre of skin over 60 minutes every 2 weeks, along with leucovorin 20 mg to rescue the bone marrow from damage due to methotrexate. They also received methylprednisolone 120 mg/day for the first 3 cycles. Each 2-week course of methotrexate was called a cycle, and doctors planned to give subjects up to 6 cycles if necessary.

Results

Seven of 15 subjects had their signs/symptoms clear and no trace of their lesion(s) was seen in X-ray and magnetic scans. This development was called a "complete response" by the doctors and occurred in 3 of 10 subjects in group one and 4 of 5 in group two. The tumours took an average of 2 months to disappear. Fifty percent of the subjects who responded to the treatment survived for about 19 months.

Of the remaining eight subjects, six did not respond to treatment after about 1 month of therapy. Four of these subjects died after an average of 51 days. The remaining two had radiation beamed at their entire brain but they died 67 and 286 days after diagnosis respectively. The two remaining subjects died of infections after they began to receive chemotherapy.

Overall, 50% of subjects survived for nearly 10 months after diagnosis of cancer. For the 7 subjects who improved when given chemo, the figure was 1.5 years. Their survival may have been increased because, after chemotherapy, they received antiviral regimens containing indinavir or ritonavir. Two of the 7 responders eventually died; one from complications due to relapsed lymphoma 1 year after cancer was first diagnosed and the other from infections 19 months after diagnosis.

Toxicity

Low levels of a group of white blood cells called neutrophils occurred as a result of chemotherapy and 6 subjects required bone marrow stimulants to boost their neutrophil counts. All in all, intravenous methotrexate therapy seems to be a major advance over standard therapy for PCNSL.

REFERENCES:

1. Jacomet C, Girard P-M, Lebrette M-G, et al. Intravenous methotrexate for primary central nervous system lymphoma in AIDS. AIDS 1997;11:1725-1730.

971201
CATE8410

Copyright © 1997 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca