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Procarbazine, Lomustine and Vincristine Toxicity in Low-Grade Gliomas

G. Jutras
K. Bélanger
N. Letarte
J.-P. Adam
D. Roberge
B. Lemieux
É. Lemieux-Blanchard
L. Masucci
C. Ménard
J.P. Bahary
R. Moumdjian
F. Berthelet
1,2 and
M. Florescu
Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
Centre hospitalier de l’Université de Montréal, Notre-Dame Hospital, Montréal, QC, Canada
Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
Department of Pharmacy at chum, Montréal, QC, Canada
Author to whom correspondence should be addressed.
Curr. Oncol. 2018, 25(1), 33-39;
Submission received: 8 November 2017 / Revised: 6 December 2017 / Accepted: 10 January 2018 / Published: 1 February 2018


Background: Procarbazine, lomustine, and vincristine (PCV) significantly improve survival outcomes in LGG (low-grade gliomas). Administration of PCV to LGG patients increased tremendously over the past years as it went from 2 patients per year between 2005 and 2012 to 23 patients in 2015 only in our centre. However, serious hematological and non-hematological adverse events may occur. The purpose of this study was to evaluate the toxicity of PCV and its clinical relevance in our practice. Methods: We retrospectively reviewed the charts of 57 patients with LGG who received PCV at the Centre hospitalier de l’Université de Montréal between 1 January 2005 and 27 July 2016. Results: Procarbazine, lomustine, and vincristine were associated with severe hematological toxicity as clinically significant grade 3 anemia, neutropenia, and thrombocytopenia occurred in 7%, 10%, and 28% of patients, respectively. Other frequent adverse events such as the increase of liver enzymes, cutaneous rash, neurotoxicity, and vomiting occurred in 65%, 26%, 60%, and 40% of patients, respectively. Patients with prophylactic trimethoprim/sulfamethoxazole had more grade 3 hematological toxicity with PCV, especially anemia (p = 0.040) and thrombocytopenia (p = 0.003) but we found no increase in PCV toxicity in patients on concurrent anticonvulsants. Patients with grade 3 neutropenia had a significantly lower survival (median survival 44.0 months vs. 114.0 months, p = 0.001). Patients who were given PCV at diagnosis had more grade 3 anemia than those who received it at subsequent lines of treatment (p = 0.042). Conclusion: Procarbazine, lomustine, and vincristine increase survival in LGG but were also associated with major hematologic, hepatic, neurologic, and cutaneous toxicity. Anti-Pneumocystis jiroveci pneumonia (PJP) prophylaxis, but not anticonvulsants, enhances hematologic toxicity.
Keywords: chemotherapy; toxicity; gliomas chemotherapy; toxicity; gliomas

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MDPI and ACS Style

Jutras, G.; Bélanger, K.; Letarte, N.; Adam, J.-P.; Roberge, D.; Lemieux, B.; Lemieux-Blanchard, É.; Masucci, L.; Ménard, C.; Bahary, J.P.; et al. Procarbazine, Lomustine and Vincristine Toxicity in Low-Grade Gliomas. Curr. Oncol. 2018, 25, 33-39.

AMA Style

Jutras G, Bélanger K, Letarte N, Adam J-P, Roberge D, Lemieux B, Lemieux-Blanchard É, Masucci L, Ménard C, Bahary JP, et al. Procarbazine, Lomustine and Vincristine Toxicity in Low-Grade Gliomas. Current Oncology. 2018; 25(1):33-39.

Chicago/Turabian Style

Jutras, G., K. Bélanger, N. Letarte, J.-P. Adam, D. Roberge, B. Lemieux, É. Lemieux-Blanchard, L. Masucci, C. Ménard, J.P. Bahary, and et al. 2018. "Procarbazine, Lomustine and Vincristine Toxicity in Low-Grade Gliomas" Current Oncology 25, no. 1: 33-39.

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