Adjuvant Temozolomide Improves Overall Survival in Anaplastic Glioma Subtype

Adjuvant temozolomide therapy after radiotherapy may significantly improve overall and progression-free survival (OS and PFS, respectively) among patients with newly diagnosed, non-co-deleted anaplastic glioma, according to a study published in The Lancet.¹

Evidence from previous studies demonstrated that administering chemotherapy to patients with chemotherapy-sensitive brain malignancies after radiotherapy did not improve OS.

For the CATNON phase 3 trial (ClinicalTrials.gov Identifier: NCT00626990), researchers enrolled 745 patients with anaplastic glioma and randomly assigned them to receive radiotherapy (59.4 Gy in 33 fractions of 1.8 Gy) alone or with adjuvant temozolomide 150 to 200mg/m² given on days 1 to 5 for 12 4-week cycles, or to receive radiotherapy with concurrent temozolomide 75mg/m² daily, alone or with adjuvant temozolomide.

At the median follow-up of 27 months, 46% of patients had disease progression and 30% had died. The adjusted hazard ratio (HR) for OS was 0.65 (99-145% CI, 0.45-0.93).

The adjuvant temozolomide group had a 5-year OS of 55.9% (95% CI, 47.2-63.8) vs 44.1% (95% CI, 36.3-51.6) among others.

The adjuvant temozolomide group had a 5-year PFS of 43.1% (95% CI, 35.0-50.9) vs 24.3% (95% CI, 17.7-31.6) among others.

Overall, 54% of patients in the non-adjuvant temozolomide arm had disease progression vs 39% of the adjuvant temozolomide arm.

The authors concluded that “further follow-up and tissue studies are needed to establish the efficacy of concurrent temozolomide chemotherapy and the effects of molecular signatures on outcome.”

Reference

1. van den Bent MJ, Baumert B, Erridge SC, et al. 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, randomized, open-label intergroup study. Lancet. 2017 Aug 8. doi: 10.1016/S0140-6736(17)31442-3 [Epub ahead of print]