An overview of current and future treatment options for adults anaplastic oligodendroglial tumors

Abstract

Introduction: Despite the identification in the early 90’s that anaplastic oligodendroglial tumours (AOT) were chemosensitive, the role and optimal timing of chemotherapy in these tumours had remained subject of debate until recently.Areas covered: Based on the long-term results of two Phase III trials – one by the Radiation Therapy Oncology Group (RTOG) and the other by the European Organization for Research and Treatment of Cancer (EORTC) – current and future treatment options for AOT are reviewed.Expert opinion: The up-dated results of the RTOG and EORTC trials have defined radiotherapy (RT) plus PCV (Procarbazine, CCNU, Vincristine) as the new standard of care for 1p/19q co-deleted AOT. In these tumors, both studies demonstrated that initial treatment with RT plus PCV was associated with an important increase of median overall survival compared to RT alone. In addition, the up-dated results of the RTOG trial suggest that non co-deleted isocitrate dehydrogenase (IDH) mutated AOT, in contrast to IDH wild type cases, might also benefit from initial treatment with RT plus PCV. In patients with 1p/19q co-deleted tumours, an important question is now to determine whether RT could be withheld until the tumor shows sign of progression in order to reduce the risk of neurocognitive deterioration. Meanwhile, these patients should be treated with RT plus PCV. In the absence of comparative studies, the authors do not recommend at this stage to replace PCV by temozolomide.