Radiotherapy and temozolomide for anaplastic astrocytic gliomas Journal Article

Authors: Nayak, L.; Panageas, K. S.; Reiner, A. S.; Huse, J. T.; Pentsova, E.; Braunthal, S. G.; Abrey, L. E.; Deangelis, L. M.; Lassman, A. B.
Article Title: Radiotherapy and temozolomide for anaplastic astrocytic gliomas
Abstract: We previously reported results of a phase II non-comparative trial that randomized patients with glioblastoma following radiotherapy to one of two different temozolomide schedules, followed by 13-cis-retinoic acid (RA) maintenance. Here we report the results of an exploratory cohort of patients accrued with anaplastic astrocytic tumors. Patients with newly diagnosed anaplastic astrocytoma (AA) or anaplastic oligo-astrocytoma (AOA) were treated with concurrent radiotherapy (60 Gy over 6 weeks) and temozolomide (75 mg/m2), and six adjuvant 28-day cycles of either dose-dense (150 mg/m2, days 1–7, 15–21) or metronomic (50 mg/m2, days 1–28) temozolomide. Subsequently, maintenance RA (100 mg/m2, days 1–21/28) was administered until disease progression. All outcome measures were descriptive without intention to compare between treatment arms. Survival was measured by the Kaplan–Meier method. There were 31 patients (21 men, 10 women) with median age 48 years (range 28–74), median KPS 90 (range 60–100). Extent of resection was gross-total in 35 %, subtotal 23 %, and biopsy 42 %. Histology was AA in 90 %, and AOA in 10 %. MGMT promoter methylation was methylated in 20 %, unmethylated in 50 %, and uninformative in 30 % of 30 tested. Median progression-free survival was 2.1 years (95 % CI 0.95–Not Reached), and overall survival 2.9 years (95 % CI 2.0–Not Reached). We report outcomes among a homogeneously treated population with anaplastic astrocytic tumors. Survival was unexpectedly short compared to other reports. These data may be useful as a contemporary historic control for other ongoing or future randomized trials. © 2015, Springer Science+Business Media New York.
Keywords: adult; cancer survival; clinical article; controlled study; human tissue; treatment response; aged; overall survival; clinical trial; constipation; fatigue; neutropenia; drug efficacy; adjuvant therapy; cancer radiotherapy; chemotherapy; temozolomide; cancer diagnosis; gene; progression free survival; multiple cycle treatment; randomized controlled trial; thrombocytopenia; radiotherapy; cohort analysis; tumor biopsy; dna methylation; histology; abdominal pain; lymphocytopenia; glioblastoma; methylated dna protein cysteine methyltransferase; kaplan meier method; isotretinoin; liver enzyme; mgmt gene; drug tolerance; drug dose sequence; exploratory research; anaplastic astrocytoma; metronomic drug administration; liver level; human; male; female; article
Journal Title: Journal of Neuro-Oncology
Volume: 123
Issue: 1
ISSN: 0167-594X
Publisher: Springer  
Date Published: 2015-05-01
Start Page: 129
End Page: 134
Language: English
DOI: 10.1007/s11060-015-1771-8
PROVIDER: scopus
PUBMED: 25920709
PMCID: PMC4606458
Notes: Export Date: 2 July 2015 -- Source: Scopus
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MSK Authors
  1. Anne S Reiner
    115 Reiner
  2. Andrew Lassman
    101 Lassman
  3. Lakshmi Nayak
    17 Nayak
  4. Lauren E Abrey
    262 Abrey
  5. Katherine S Panageas
    312 Panageas
  6. Jason T Huse
    127 Huse