Long-term results of two cooperative group phase III trials have determined radiation therapy and chemotherapy is the new standard of care for newly diagnosed anaplastic oligodendroglioma with 1p19q loss,” commented Eric L. Chang, MD, of the USC Norris Cancer Hospital and Keck School of Medicine, Los Angeles. “Perseverance in data and tumor collection established 1p19q as a predictive marker (in addition to a prognostic marker) and underscores the importance of prospective tumor collection in hypothesis-based clinical trials.”
Practical Implications
The trials have several implications for current practice, he maintained. “Radiation therapy alone is no longer adequate for treatment of patients with anaplastic oligodendroglioma with 1p19q codeletion: Existing data support first-line treatment with radiation therapy and chemotherapy.”
However, “the optimal treatment paradigm has not been established, and the sequencing has also not been established—whether it should be chemotherapy followed by radiation therapy, radiation therapy followed by chemotherapy, or whether it should be temozolomide vs PCV.” And perhaps not surprisingly, a recent survey of specialists found wide variation in the treatment of choice for anaplastic oligodendroglioma, with no apparent consensus.1
In any case, the new trial results “emphasize the need to consider anaplastic oligodendroglioma as two distinct entities based on the 1p19q status,” Dr. Chang concluded. “What is the optimal regimen for anaplastic oligodendroglioma with 1p19q loss?... And are there unique molecular targets resulting from the translocation and chromosomal loss? These are areas for future directions and research.” ■
Reference
1. Abrey LE, Louis DN, Paleologos N, et al: Oligodendroglioma Study Group: Survey of treatment recommendations for anaplastic oligodendroglioma. Neuro Oncol 9:314-318, 2007.
2. Bible KC, Suman VJ, Molina JR, et al: Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: Results of a phase 2 consortium study. Lancet Oncol 11:962-972, 2010.
