American Journal of Medical Sciences and Medicine
ISSN (Print): 2327-6681 ISSN (Online): 2327-6657 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Sciences and Medicine. 2014, 2(2), 37-40
DOI: 10.12691/ajmsm-2-2-2
Open AccessCase Report

Immediate Induction and Consolidation Therapy May Improve Outcomes for Patients with Anaplastic Astrocytoma: a Case Series

Jonathan D. Santoro1, and Julie Kanter2

1Lucille Packard Children’s Hospital at Stanford University School of Medicine, Department of Pediatrics, Palo Alto, CA

2Medical University of South Carolina, Department of Pediatrics, Division of Hematology-Oncology, Charleston, SC

Pub. Date: March 06, 2014

Cite this paper:
Jonathan D. Santoro and Julie Kanter. Immediate Induction and Consolidation Therapy May Improve Outcomes for Patients with Anaplastic Astrocytoma: a Case Series. American Journal of Medical Sciences and Medicine. 2014; 2(2):37-40. doi: 10.12691/ajmsm-2-2-2


Despite advances in chemotherapy and radiation, prognosis for all patients with high grade gliomas remains poor. In anaplastic astrocytomas (WHO III) GTR is associated with a 5 year progression free survival (PFS) of 44% compared to 22% when surgical resection is sub-total. While initial studies demonstrated post-radiation chemotherapy improved outcomes, successive chemotherapeutic trials were unable to significantly improve outcomes. Recent trials in adults with recurrent glioblastoma multiforme have shown that the combination of Bevacixumab and Irinotecan have improved 6 month PFS was 46% and overall survival (OS) at 6 months of 77%. Although these adult studies were encouraging, results were not replicated in children with similar pathology. This case series presents two pediatric patients with anaplastic astrocytoma treated with an induction therapy of Temozolamide (90mg/m2 x 42 days) plus standard radiation therapy (5400 cGy) very shortly after surgical resection, followed by a consolidation treatment regimen of 8-cycles of chemotherapy with Bevacizumab (10mg/m2) and Irinotecan (125mg/m2), given on days 1 and 15 of 21 day cycles. These patients did extraordinarily well on this therapeutic regimen, surpassing expectations, with one patient having 18 months of PFS and one patient achieving CR1 at the time of this publication for 20 months. The treatment regimen was well tolerated without unanticipated toxicities or episodes of severe neutropenia induced by this therapy. We are encouraged by the improvements in PFS and OS in these two patients as well as the acceptability of toxicity in this case series and thus recommend prompt induction and consolidation chemotherapy following resection of these neoplasms.

high grade astrocytoma chemotherapy tumor brain bevacizumab irinotecan

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 4


[1]  Broniscer A, Chintagumpala M, Fouladi M, Krasin M, Kocak M, Bowers D, Iacono L, et al. Temozolomide after radiotherapy for newly diagnosed high-grade glioma and unfavorable low-grade glioma in children. J Neurooncol. 76: 313-319, 2006.
[2]  Finlay J, Boyett J, Yates A, Wisoff J, Milstein J, Geyer J, et al. Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. Childrens Cancer Group. J Clin Oncol. 13: 112-123, 1995.
[3]  Finlay J, Zacharoulis S. The treatment of high grade gliomas and diffuse intrinsic pontine tumors of childhood and adolescence: a historical-and futuristic-perspective. J Neurooncol. 75: 253-266, 2005.
[4]  Gruber M, Buster W. Temozolomide in combination with irinotecan for treatment of recurrent malignant glioma. Am J Clin Oncol. 27: 33-38, 2004.
[5]  Lai A, Tran A, Nghiemphu P, Pope W, Solis O, Selch M, et al. Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme. 29: 142-8, 2011.
[6]  Melean G, Sestini R, Ammannati F, Papi L. Genetic insights into familial tumors of the nervous system. Am J Med Genet C Semin Med Genet. 129C: 74-84, 2004.
[7]  Mueller S, Chang S. Pediatric brain tumors: current treatment strategies and future therapeutic approaches. Neurotherapeutics. 6: 570-586, 2009.
[8]  Narayana A, Kunnakkat S, Chacko-Mathew J, Gardner S, Karajannis M, Raza S, et al. Bevacizumab in recurrent high-grade pediatric gliomas. Neuro Oncol. 12: 985-90, 2011.
[9]  Perkins S, Rubin J, Leonard J, Smyth M, El Naqa I, Michalski J, et al. Glioblastoma in children: a single-institution experience. Int J Radiat Oncol Biol Phys 80: 1117-21, 2011.
[10]  Pettorini B, Park Y, Caldarelli M, Massimi L, Tamburrini G, Di Rocco C. Radiationinduced brain tumours after central nervous system irradiation in childhood: a review. Childs Nerv Syst. 24: 793-805. 2008.
[11]  Pollack I, Boyett J, Yates A, Burger P, Gilles F, Davis R, et al. The influence of central review on outcome associations in childhood malignant gliomas: results from the CCG-945 experience. Neuro Oncol. 5: 197-207, 2003.
[12]  Pollack I. Brain tumors in children. N Engl J Med. 331: 1500-7, 1994.
[13]  Qaddoumi I, Sultan I, Gajjar A. Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the Surveillance, Epidemiology, and End Results database. 115: 5761-70. 2009.
[14]  Reulecke B, Erker C, Fiedler B, Niederstadt T, Kurlemann G. Brain tumors in children: initial symptoms and their influence on the time span between symptom onset and diagnosis. J Child Neurol. 23: 178-183, 2008.
[15]  Sposto R, Ertel I, Jenkin R, Boesel C, Venes J, Ortega J, et al. The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. A report from the Childrens Cancer Study Group. J Neurooncol. 7: 165-77, 1989.
[16]  Stark-Vance V: Bevacizumab and CPT-11 in the treatment of relapsed malignant glioma. Neuro-Oncology 7: 369, 2005.
[17]  Tamber M, Rutka J. Pediatric supratentorial highgrade gliomas. Neurosurg Focus. 15:14 (2): e-pub, 2003.
[18]  Varley J, McGown G, Thorncroft M, Santibanez-Koref M, Kelsey A, Tricker K, et al. Germline mutations of TP53 in Li-Fraumeni families: an extended study of 39 families. Cancer Res. 57: 3245, 1997.
[19]  Vredenburgh J, Desjardins A, Herndon J, Marcello J, Reardon D, Quinn J, et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol. 25: 4722-9, 2007
[20]  Ward B, Gutmann D. Neurofibromatosis 1: from lab bench to clinic. Pediatr Neurol. 32: 221-228. 2005.
[21]  Wisoff JH, Boyett JM, Berger MS, Brant C, Li H, Yates A, et al. Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children’s Cancer Group trial no. CCG-945. J Neurosurg. 89: 52-59, 1998.