Doubling the Lifespan of Brain Cancer Patients

Anaplastic oligodendroglioma responds best to chemotherapy plus radiation

(RxWiki News) The treatment of cancer is constantly evolving. Standards of care are being replaced by new approaches. One such change has dramatically expanded the outlook for people with one type of brain cancer.

Two long-term clinical trials have found that, compared to radiation alone, a combination of chemotherapy and radiation more than doubled the lifespans of people with anaplastic oligodendroglioma (AOG). These patients had specific chromosome mutations.

These findings have defined a new standard of care for this rare cancer that strikes about 2,000 people in the United States every year.

"If you start having headaches out of the blue, visit your doctor."

The two trials were started in the 1990's. The Radiation Therapy Oncology Group (RTOG) trial was conducted by the National Cancer Institute and led by Gregory Cairncross, MD, of the University of Calgary. The EORTC trial was headed by Prof. MJ van den Bent of the Neuro-Oncology Unit at Daniel den Hoed Cancer Center/Erasmus University Hospital in Rotterdam, Netherlands.

About half of all patients with AOG have missing or deleted parts of chromosomes 1 and 19. The combination therapy was most effective in these patients.  

In the RTOG trial, researchers looked at the long-term outcomes of patients who received either radiation alone or high-dose chemotherapy with procarbazine (Matulane), lomustine (CeeNu) and vincristine (Vincasar), a regimen known as PCV, followed by radiation.

Patients without these genetic mutations lived less than three years following either treatment.

In the other trial, patients received either radiation alone or radiation followed by standard dose PCV. Survival data had not yet been calculated, but according to researchers, the trends for those with the chromosome deletions appeared to mirror those found in the RTOG trial.

In an accompanying editorial, Mark Gilbert, MD, professor and deputy chair of the Neuro-Oncology division at The University of Texas MD Anderson Cancer Center, wrote, “These studies establish a new standard of care for patients with [anaplastic oligodendroglioma] tumors that harbor the 1p19q loss. No longer is radiation considered an adequate treatment for this patient population.”

Despite these findings, Dr. Cairncross said that the most effective chemo regimen has still not been confirmed. He and his colleagues indicated that because of its effectiveness against glioblastoma, the most common form of brain cancer, and better side effects profile, many oncologists prefer temozolomide (Temodar) over the PCV regimen.

dailyRx News reached out to Keith L. Black, MD, chair and professor of Cedars-Sinai’s Department of Neurosurgery, director of the Cochran Brain Tumor Center, director of the Maxine Dunitz Neurosurgical Institute and the Ruth and Lawrence Harvey Chair in Neuroscience. "Compared to PCV, Temodar is better tolerated and more effective in the most aggressive glioma, GBM (glioblastoma multiforme). Most neuro-oncologists currently treat anaplastic oligodendroglioma with Temodar rather than PCV based on the belief that Temodar may be more effective and have a better safety profile," Dr. Black said.

Findings from these trials were published in the January issue of the Journal of Clinical Oncology.

Review Date: 
February 4, 2013