Meningiomas are the most common primary intracranial neoplasms.[1] Grade I meningiomas are benign and managed by surgical resection alone.[1] However, Grade II and III require adjuvant radiation and are characterized by their
aggressive nature and high rates of recurrence.[1] Unresectable recurrent high-grade meningiomas, refractory to radiotherapy, have
a dismal prognosis with 26% progression-free survival of 6 months.[2] Systemic chemotherapy with interferon-α and somatostatin analogs, sunitinib, and
bevacizumab has been tried with limited efficacy.[3] Recently, Takeda et al demonstrated in vitro and in vivo activity of gemcitabine
in high-grade meningiomas.[4]
Inspired by these results, at our institute, we have given gemcitabine to three patients
of recurrent meningioma on compassionate grounds. All these three patients had earlier
underwent surgery, radiation, followed by reradiation at first progression and were
not a candidate for local therapy anymore. The time to progression over immediate
previous treatment was 1 month in the first patient and 5 months in the second and
third patients. The schedule of gemcitabine used was weekly 1,000 mg/m2 on day 1, day 8, and day 15 for a 28-day cycle. The best response was stable disease
in all three patients. The number of cycles of gemcitabine received was 12, 5, and
10 in the first, second, and third patient, respectively. No major adverse events
were observed except Grade II thrombocytopenia in one patient. Time to progression
was 12 months in the first patient, 6 months in second patient, and 11 months in the
third patient. The results are exciting and warrant further evaluation of this drug
in this setting. Currently, a single-arm phase 2 trial is undergoing at our institute
(CTRI/2019/02/017499) evaluating the efficacy of gemcitabine in recurrent Grade II/III
meningiomas.
