Impact of upfront adjuvant chemoradiation on survival in patients with molecularly defined oligodendroglioma: the benefits of PCV over TMZ.

Autor: Rincon-Torroella J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.; Laboratory of Experimental Oncological Neurosurgery, Neurosurgery Service, Hospital Clinic de Barcelona, Barcelona, Spain.; Programa de Doctorat de Medicina i Recerca Translacional, Universitat de Barcelona, Barcelona, Spain., Rakovec M; Department of Neurosurgery, University of Maryland Medical Medical Center, Baltimore, USA., Kalluri AL; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Jiang K; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Weber-Levine C; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Parker M; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Raj D; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Materi J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Sepehri S; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Ferres A; Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain., Schreck KC; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Aldecoa I; Department of Pathology, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.; Neurological Tissue Bank of the Biobank Hospital Clinic Barcelona-FCRB/ IDIBAPS, Barcelona, Spain., Lucas CG; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Sair HI; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; The Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA., Redmond KJ; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Holdhoff M; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Weingart J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Brem H; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Sánchez JJG; Laboratory of Experimental Oncological Neurosurgery, Neurosurgery Service, Hospital Clinic de Barcelona, Barcelona, Spain.; Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain., Ye X; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA., Bettegowda C; Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building, Room 118, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. cbetteg1@jhmi.edu.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2025 Jan; Vol. 171 (1), pp. 35-45. Date of Electronic Publication: 2024 Oct 09.
DOI: 10.1007/s11060-024-04829-6
Abstrakt: Purpose: Oligodendroglioma is an adult-type diffuse glioma defined by 1p/19q codeletion and IDH1/2 mutation. Treatment includes surgery followed by observation alone in select low-grade tumors, or combination radiation and chemotherapy with procarbazine, lomustine, and vincristine (PCV) or temozolomide (TMZ). While prospective studies investigating treatments for molecularly defined oligodendrogliomas are ongoing, this retrospective study analyzes the relationship between adjuvant regimens and progression-free survival (PFS).
Methods: Adults with IDH-mutant, 1p/19q codeleted oligodendroglioma (WHO grade 2 or 3) who underwent surgery between 2005 and 2021 were identified. Clinical data, disease characteristics, treatment, and outcomes were collected.
Results: A total of 207 patients with grade 2 and 70 with grade 3 oligodendrogliomas were identified. Median (IQR) follow-up was 57 (87) months. Patients with grade 3 tumors who received adjuvant radiation and PCV had longer median PFS (> 110 months) than patients who received radiation and TMZ (52 months, p = 0.008) or no adjuvant chemoradiation (83 months, p = 0.03), which was not seen in grade 2 tumors (p = 0.8). In multivariate analysis, patients who received PCV chemotherapy (Relative Risk [95% CI] = 0.24[0.05-1.08] and radiotherapy (0.46[0.21-1.02]) trended towards longer PFS, independently of grade.
Conclusion: Adjuvant radiation and PCV are associated with improved PFS over radiation with TMZ in patients with grade 3 molecularly defined oligodendrogliomas, and all-grade patients treated with PCV trended towards decreased risk of recurrence and progression. These results highlight the importance of ongoing clinical trials investigating these treatments.
Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Johns Hopkins Institutional Review Board (IRB00282685). Informed consent was waived due to the retrospective, non-interventional design of this study. Competing interests: On behalf of all authors, the corresponding author states no conflicts of interest. KJR: Research support from Elekta AB, Accuray and Canon; Data Safety Monitoring Board for BioMimetix; Travel expenses from Brainlab, Elekta AB, Accuray and Icotec; Consulting fees Icotec. MH: Parexel - data safety monitoring board; Advarra - data safety monitoring board; Bayer, AnHeart Therapeutics Inc, and Servier -- advisory board. Reporting guidelines: We found no applicable reporting guidelines that would apply to this article. By following the EQUATOR reporting guidelines decision tree, ( http://www.equatornetwork.org/wp-content/uploads/2013/11/20160226-RG-decision-tree-for-Wizard-CC-BY-26-February-2016.pdf ), we found that none of the most popular checklists are appropriate for our study design.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: