69 Review of outcomes at a tertiary cancer centre of procarbazine (third line) and etoposide (fourth line) chemotherapy for recurrent gliomas

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Abstract Introduction There is no standard recommended third- or fourth-line chemotherapy treatment for patients with recurrent gliomas. At our tertiary cancer centre, CCNU, procarbazine and etoposide are commonly used sequentially as second-, third- and fourth-line treatments. This review assessed progression free survival (PFS), overall survival (OS) and tolerability of single agent procarbazine and etoposide chemotherapy. Methods All patients coded glioma, WHO grade 2 – 4, who commenced third line procarbazine or fourth line etoposide between 1st November 2016 and 31st December 2024 were identified. 94 patients were analysed for procarbazine and 21 patients for etoposide. Age range 23 – 77y. Treatment-related toxicity was reviewed. Data analysis was performed June 2025 with SPSS for survival. Results For the 94 patients commencing procarbazine, duration of treatment was mean 84 days, median 68 days with a maximum duration of 453 days. The mean PFS was 4.2 months, median 3 months. 6 months PFS was 10%. The mean OS was 10 months with a median 6 months. 12 months OS was 19.8%. For the 21 patients commencing etoposide, duration of treatment was a mean 141 days, median 80 days with a maximum duration of 1127 days. Mean PFS was 5 months, median 3 months. 6 months PFS was 18%. The mean OS was 16 months, median OS 7 months. 12 months OS was 40%. 6 patients discontinued treatment due to toxicity, mainly thrombocytopaenia or fatigue. Dietary restrictions were well tolerated. Conclusions Procarbazine and etoposide were generally stopped after 3 cycles, reflecting progression on first MRI. Median OS following procarbazine was 6 months and following etoposide was 7 months. However, a few patients responded exceptionally well. Chemotherapy was well tolerated, with few discontinuing due to toxicity.