WEDNESDAY, Jan. 30 (HealthDay News) -- Intravenous methotrexate is promising as induction therapy for primary central nervous system lymphoma, or PCNSL, and more research is needed to determine optimal methotrexate-based combination therapies, according to an article published in the Jan. 29 issue of Neurology.
Elizabeth R. Gerstner, M.D., of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues report data from a phase II trial in which 25 HIV-negative patients with newly diagnosed PCNSL were treated with intravenous methotrexate every two weeks until a radiographically determined complete response was achieved, or for a maximum of eight induction doses. Patients achieving a complete response were then treated with two consolidation cycles every two weeks followed by 11 maintenance cycles.
Methotrexate induction led to complete response in 12 of the 25 patients (52 percent), the researchers report. Five of the 12 patients had not relapsed after a median follow-up of 6.8 years. There were 11 deaths from progressive disease or unknown cause, and three deaths from other illnesses, the report indicates. Median overall survival was 55.4 months, which is superior to the 11.6-month median survival associated with whole brain irradiation. Methotrexate toxicity was modest, with only 12 of 25 patients developing grade 3 or 4 toxicity after 287 cycles.
"High-dose methotrexate alone or in combination with other therapies is the most effective treatment available for PCNSL. Future studies are necessary to identify the optimal methotrexate-based combination regimen that will produce maximal efficacy and acceptable toxicity," the authors conclude.
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