Benefit with adjuvant chemotherapy in anaplastic astrocytoma

Abstract

The role of chemotherapy for newly diagnosed anaplastic gliomas, particularly when combined with radiotherapy, has long been unresolved. Over the past few decades, despite no conclusive data, study findings have suggested that the addition of nitrosourea-based chemotherapy to radiotherapy could be beneficial. The NOA-04 trial 1 Wick W Hartmann C Engel C et al. NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol. 2009; 27: 5874-5880 Crossref PubMed Scopus (668) Google Scholar revealed that initial treatment with chemotherapy (either temozolomide or procarbazine, lomustine, and vincristine [PCV]) or radiotherapy alone yielded similar results. Survival of patients with anaplastic glioma has been recognised as being strongly dependent on the presence or absence of the favourable 1p/19q co-deletion. This discovery resulted in secondary analyses of US and European trials, revealing improved survival in patients with co-deleted tumours who received combined radiation and PCV chemotherapy. 2 Cairncross G Wang M Shaw E et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2012; 31: 337-343 Crossref PubMed Scopus (777) Google Scholar , 3 van den Bent MJ Brandes AA Taphoorn MJ et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol. 2012; 31: 344-350 Crossref PubMed Scopus (836) Google Scholar Separately, clear benefits were found with adding temozolomide to radiotherapy to treat newly diagnosed glioblastoma, 4 Stupp R Mason WP van den Bent MJ et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. 2005; 352: 987-996 Google Scholar which led to investigations of whether radiation plus temozolomide would benefit patients with non-co-deleted anaplastic gliomas (ie, anaplastic astrocytomas). Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup studyAdjuvant temozolomide chemotherapy was associated with a significant survival benefit in patients with newly diagnosed non-co-deleted anaplastic glioma. Further analysis of the role of concurrent temozolomide treatment and molecular factors is needed. Full-Text PDF