“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.
CHICAGO – Patients with anaplastic glioma without 1p/19q co-deletion benefit from adjuvant chemotherapy, according to early results from a European phase III trial. The estimated five‐year survival rates were 56% with radiation therapy and adjuvant temozolomide versus 44% without adjuvant temozolomide. Addition of adjuvant temozolomide also delayed disease progression by more than two years.
The study will be featured in a press briefing today and presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting.
“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, a 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.”
About the Study
Co-deletion of chromosome arms 1p and 19q occurs in a specific type of brain cancer. Patients who have this genetic abnormality 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 co-deletion (a separate trial focuses on patients who have this marker). Researchers randomly assigned 748 patients to four different treatment groups:
- Radiation therapy alone
- Temozolomide during radiation therapy
- Temozolomide during and after radiation therapy
- Temozolomide after radiation therapy (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 months 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 temozolomide; 56% of patients were alive at five 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.
Temozolomide is an oral drug and is generally well tolerated by patients. The most common toxicities in the temozolomide study arms were mainly hematologic (e.g., low platelets and white blood cells), with severe toxicity in 5‐10% of patients.
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.
About Anaplastic Glioma
A glioma is a tumor that grows from a glial cell, which is a supportive cell in the brain. Anaplastic gliomas are uncommon, accounting for about 2% of primary brain cancers and highly aggressive tumors. They often occur in young adults – the median age at diagnosis is 35 to 50 years. Grade III anaplastic gliomas can grow quickly and progress to glioblastoma within a few years of diagnosis.
This study received funding from an unrestricted grant from Schering Plough/MSD, by the EORTC Cancer Research Fund, by Cancer Research UK (trial number CRUK/07/028), by NRG grants U10CA180868 (NRG Oncology Operations) and U10CA180822 (NRG Oncology SDMC); and by Cancer Australia (grants APP1078665 and APP1026842). Temozolomide was made available for this study by Schering Plough/MSD.
View the full abstract.
For Your Readers:
View the disclosures for the 2016 ASCO Annual Meeting News Planning Team.
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