The use of the chemotherapy agent Temodar (temozolomide) following radiation therapy significantly improves time to cancer progression and overall survival among patients with newly diagnosed anaplastic glioma without 1p/19q co-deletions. These results were recently presented at the 2016 annual meeting of the American Society of Clinical Oncology (ASCO).
Anaplastic gliomas are a type of brain cancer that start in a glial cell. Anaplastic gliomas are not common, accounting for only 2% of brain cancers. However, they can be very aggressive and often occur in young adults. Grade III anaplastic glioma refers to an aggressive glioma that can progress into glioblastoma (the most aggressive type of brain cancer) within a few years of its diagnosis.
A recent trial, referred to as the CATNON trial, evaluated the effectiveness of different timing in the delivery of temozolomide in relation to radiation therapy in patients with anaplastic glioma. The trial included approximately 750 patients with newly diagnosed, grade III anaplastic glioma without 1p/19q co-deletions. Patients in the trial were treated with one of the following treatment regimens:
- Radiation alone
- Temozolomide delivered at the same time as radiation therapy (concurrent)
- Temozolomide delivered after all radiation was completed (adjuvant temozolomide)
- Concurrent temozolomide and radiation, followed by adjuvant temozolomide
An interim planned analysis reported the following outcomes:
- Overall survival has not yet been reached for the patients treated with adjuvant temozolomide (treatment groups 3 and 4), while overall survival was 41.4 months for patients not treated with adjuvant temozolomide (treatment groups 1 and 2).
- The median time of survival with no cancer progression was 42.8 months for patients treated with adjuvant temozolomide, compared with only 19 months for patients who did not receive adjuvant temozolomide.
- At 5 years, survival rates were 56% for patients who received adjuvant temozolomide, compared with 44% for those who did not receive adjuvant temozolomide.
- The most common serious side effects were low levels of platelets and low levels of immune cells.
- Subgroup analyses and longer follow-up will help determine the role of concurrent temozolomide among patients receiving adjuvant temozolomide. In addition, several genetic mutations and their associations to long-term outcomes are being evaluated.
These results indicate that temozolomide delivered after completion of radiation therapy, whether or not it is given concurrently with radiation therapy, significantly improves the time to cancer progression, as well as survival among patients with newly diagnosed, grade III anaplastic glioma without 1p/19q co-deletions.
Longer follow-up and genetic analyses will further elucidate the role of adjuvant temozolomide among this patient population.
Reference: Van Den Bent M, Erridge S, Vogelbaum M, et al. Results of the interim analysis of the EORTC randomized phase III CATNON trial on concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q co-deletion: An Intergroup trial. Proceedings from the 2016 annual meeting of ASCO. LBA2000. Available at: https://abstracts.asco.org/176/AbstView_176_162108.html. Accessed June 7, 2016.
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