The Observation Of Objective Response For The Treatment Of Primary Central Nervous System Lymphoma With Irinotecan

Background: PCNSL(Primary central nervous system lymphoma)was originated from primary central nervous system malignant tumor,its incidence has a increasing trend among these years.Although the HD-MTX(high-dose methotrexate)chemotherapy after radiotherapy has been regarded as a first-line therapy,the risk of adverse responses including nerve toxicity,severe bone marrow suppression,kidney failure,liver damage and gastrointestinal reaction may increase especially for patients with poor constitution or old age.Besides,most of primary hospitals can't monitor the methotrexate concentration in blood,which limits the application of HD-MTX.What's more,PCNSL has a high recurrence rate and few drugs can be used when tumor reappear because most of chemotherapy drugs cannot permeate through the blood brain barrier.Recently,topoisomerase inhibitors got advantages in CNS tumors.Among them,CPT-11 achieved a certain effect in glioma,meningeal and brain metastases.Objective: Discuss the objective response and evaluate the safety of CPT-11(Irinotecan)in PCNSL patients who was failed in the first-line chemotherapy.Methods: 4 patients who suffered from PCNSL with tumor progression or recurrence at the second hospital of Dalian medical university from October 2015 to January 2016 were collected in this study.CPT-11 alone or associated with Ara-C was given to these patients at least two cycles(Single drug regimen: CPT-11 180mg/m2 d1 ivgtt,21 days a cycle.Combination regimen: CPT-11 180mg/m2 d1 ivgtt,Ara-C 1.5g/m2 q12 h d1-2 ivgtt,21 days a cycle).Then the objective response was evaluated by Karnofsky Performance Status and the RECIST standard.The adverse responses were evaluated according to NCI-CTC 3.0.Results: All of the patients have accepted at least two cycles of CPT-11 alone or combined chemotherapy.The clinical efficacy was evaluated: 2 cases of patients with PR,2 cases with SD.Only one patient suffered from the IV degree of bone marrow suppression which get better after treatment.No patient appeared severe diarrhea.Conclusion: CPT-11 could be used to cure the PCNSL patients with tumor progression or recurrence with good curative effect and security.This drug may worth clinical application.