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ASCO 2016: Chemotherapy Improves Outcomes for Certain Patients With Anaplastic Glioma

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Key Points

  • The median progression-free survival was more than double in patients who received adjuvant temozolomide group compared those treated without adjuvant temozolomide (42.8 vs 19 months).
  • Five-year overall survival was 56% with adjuvant temozolomide vs 44% with radiation therapy alone or with temozolomide given during radiation therapy.
  • Future research will focus on identifying patients who are most likely to benefit from adjuvant temozolomide.

For a more in-depth look at these data, please click here.

Patients with anaplastic glioma without 1p/19q codeletion benefit from adjuvant chemotherapy, according to early results from a European phase III trial. The estimated 5-year survival rates were 56% with radiation therapy and adjuvant temozolomide vs 44% without adjuvant temozolomide. Addition of adjuvant temozolomide also delayed disease progression by more than 2 years.

The study by van den Bent et al was featured in a press briefing today at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract LBA2000).

Anaplastic gliomas are uncommon, accounting for about 2% of primary brain cancers and highly aggressive tumors. They often occur in young adults, with a median age at diagnosis of 35 to 50 years. Grade III anaplastic gliomas can grow quickly and progress to glioblastoma within a few years of diagnosis.

“Until this study, doctors had no evidence to support the use of adjuvant temozolomide in patients with grade III anaplastic glioma,” said lead study author Martin J. van den Bent, MD, Professor of Neuro-oncology at Erasmus MC Cancer Center in Rotterdam, The Netherlands. “These findings should expand treatment choices and change the way we treat patients with this rare form of brain cancer.”

To see Dr. van den Bent discuss this study with The ASCO Post, please click here.

CATNON Study

Patients who have codeletion of chromosome arms 1p and 19q tend to respond better to chemotherapy and live longer. The Concurrent and Adjuvant Temozolomide Chemotherapy in Non-1p/19q Deleted Anaplastic Glioma (CATNON) trial was limited to patients who lack 1p/19q codeletion; a separate trial focuses on patients who have this marker. Researchers randomly assigned 748 patients to four different treatment groups: radiation therapy alone, radiation therapy plus concurrent temozolomide, radiotherapy plus adjuvant temozolomide, and radiotherapy plus both concurrent and adjuvant temozolomide.

The study was conducted by the European Organisation for Research and Treatment of Cancer (EORTC) and enrolled patients in 118 institutions in Europe, North America, and Australia.

Patients who received temozolomide after radiation therapy with or without concurrent temozolomide had slower disease progression than those treated without adjuvant therapy. The median time to disease progression was more than double in the adjuvant temozolomide group (42.8 vs 19 months).

The median overall survival has not been reached in patients treated with adjuvant temozolomide. Long-term survival estimates also support the use of adjuvant temozolamide; 56% of patients were alive at 5 years with adjuvant temozolomide compared to 44% with radiation therapy alone or with temozolomide given during radiation therapy. The results of the temozolomide treatment given only during radiation therapy are not yet available and final data from this study are expected in 2020.

The most common toxicities in the temozolomide study arms were mainly hematologic (eg, low platelets and white blood cells), with severe toxicity in 5% to 10% of patients.

Next Steps

“As physicians, our goal is to make every treatment matter, which includes recommending only treatments that our patients need—no more and no less. This study offers a good answer to a long-standing question, showing that adding temozolomide following radiation or concurrent chemoradiation offers clear benefits. For decades, anaplastic glioma has proven not only hard to treat, but also hard to study because it is so rare, making this finding even more important,” said Brian Alexander, MD, MPH, ASCO Expert in brain cancers.

Future research will focus on identifying patients who are most likely to benefit from adjuvant temozolomide. The researchers plan to assess or re-examine additional genetic abnormalities known to affect prognosis in this cancer: MGMT promotor methylation and IDH mutation.

This study was supported by Schering Plough/MSD, the EORTC Cancer Research Fund, Cancer Research UK, NRG, and Cancer Australia. Temozolomide was made available for this study by Schering Plough/MSD.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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