14 recurrent patients - 200 mg /m2/ day x 5 days / month Objective response - 10 Partial response 2 ependymomas after 6 and 10 cycles 2 brain stem Complete response - 1 recurrent medulloblastoma - 6 months Epelman , SIOP 2002. Temozolomide Phase II – Response.
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14 recurrentpatients - 200 mg/m2/day x 5 days/month Objectiveresponse - 10 Partialresponse 2 ependymomasafter 6 and 10 cycles 2 brainstem Complete response - 1 recurrentmedulloblastoma - 6 months Epelman, SIOP 2002 TemozolomidePhase II – Response
Future Young Children with Ependymoma • Will highly focused irradiation (with or without chemotherapy) for younger children produce: • improved long term disease-free survival? • preserved/acceptable cognitive functioning- especially, but not exclusively, children with supratentorial primaries? • acceptable freedom from second irradiation-induced malignancies?
Future Young Children with Ependymoma • Eventual predictive value of molecular markers? • Prognostic differences between Grades II (cellular) and III (anaplastic) ependymomas? • Prognostic differences between supratentorial and infratentorialependymomas?
Future Young Children with Ependymoma • Incompletely resected tumor: - Intensive induction (Head Start like +/- AuSCT?) followed by metronomic low-dose long term chemotherapy? • Completely resected tumor: • Metronomic low-dose long term chemotherapy only?