Treatment: Chemotherapy

Chapter 5 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

Given the theoretical long-term risks associated with RT, chemotherapy (ChT) has been widely evaluated as a treatment of LGG. In small phase II trials, ChT resulted in similar PFS, OS and response rates as RT.

Most trials used procarbazine, lomustine and vincristine (PCV), which was later replaced by temozolomide (TMZ), showing a better tolerability and fewer side effects.

To validate this impression, a randomised phase III trial of high-risk LGG patients (age >40 years, neurological deficit or progredient lesion) compared the outcomes of standard RT versus 12 cycles of TMZ (EORTC 22033-26033). After a median follow-up of 4 years, PFS was similar in both groups. OS data are not yet mature.

Molecular subgroup analysis of this study showed that for patients with IDHmt 1p/19q codeleted tumours, no difference in PFS was present between TMZ and RT. For these patients, treatment with ChT first would allow delaying RT. However, patients with IDHmt 1p/19q non-codeleted tumours showed significantly longer PFS when treated with RT compared with TMZ.

Revision Questions

  1. Is ChT superior to RT to treat LGGs?
  2. Should patients be treated based on the molecular profile of their tumour?
  3. Which subgroup of LGGs is most likely to benefit from ChT?

« Previous Page Next Page »

Last update: 18 September 2017