Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma.

Abstract:

OBJECTIVE:To explore an association with survival of modifying the current standard of care for patients with newly diagnosed glioblastoma of surgery followed by radiotherapy plus concurrent and 6 cycles of maintenance temozolomide chemotherapy (TMZ/RT → TMZ) by extending TMZ beyond 6 cycles. METHODS:The German Glioma Network cohort was screened for patients with newly diagnosed glioblastoma who received TMZ/RT → TMZ and completed ≥6 cycles of maintenance chemotherapy without progression. Associations of clinical patient characteristics, molecular markers, and residual tumor determined by magnetic resonance imaging after 6 cycles of TMZ with progression-free survival (PFS) and overall survival (OS) were analyzed with the log-rank test. Multivariate analyses using the Cox proportional hazards model were performed to assess associations of prolonged TMZ use with outcome. RESULTS:Sixty-one of 142 identified patients received at least 7 maintenance TMZ cycles (median 11, range 7-20). Patients with extended maintenance TMZ treatment had better PFS (20.5 months, 95% confidence interval [CI] 17.7-23.3, vs 17.2 months, 95% CI 10.2-24.2, p = 0.035) but not OS (32.6 months, 95% CI 28.9-36.4, vs 33.2 months, 95% CI 25.3-41.0, p = 0.126). However, there was no significant association of prolonged TMZ chemotherapy with PFS (hazard ratio [HR] = 0.8, 95% CI 0.4-1.6, p = 0.559) or OS (HR = 1.6, 95% CI 0.8-3.3, p = 0.218) adjusted for age, extent of resection, Karnofsky performance score, presence of residual tumor, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, or isocitrate dehydrogenase (IDH) mutation status. CONCLUSION:These data may not support the practice of prolonging maintenance TMZ chemotherapy beyond 6 cycles. CLASSIFICATION OF EVIDENCE:This study provides Class III evidence that in patients with newly diagnosed glioblastoma, prolonged TMZ chemotherapy does not significantly increase PFS or OS.

journal_name

Neurology

journal_title

Neurology

authors

Gramatzki D,Kickingereder P,Hentschel B,Felsberg J,Herrlinger U,Schackert G,Tonn JC,Westphal M,Sabel M,Schlegel U,Wick W,Pietsch T,Reifenberger G,Loeffler M,Bendszus M,Weller M

doi

10.1212/WNL.0000000000003809

subject

Has Abstract

pub_date

2017-04-11 00:00:00

pages

1422-1430

issue

15

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000003809

journal_volume

88

pub_type

杂志文章,多中心研究
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    authors: Bataller L,Wade DF,Graus F,Stacey HD,Rosenfeld MR,Dalmau J

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    doi:

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    pub_type: 杂志文章

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