New approach for the treatment of malignant brain tumors: Primary chemotherapy as an equivalent treatment option
(1 October 2009: VIDYYA MEDICAL NEWS SERVICE) -- Two studies recently conducted by the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) have shown that combined radiochemotherapy according to current standard practice does not yield better therapy results than radiotherapy alone. The NOA (Neurooncology Working Group) study has now also proven that chemotherapy alone after surgical removal of the tumor has an equivalent result. “This additional treatment option facilitates the further development of the treatment plan in new combinations with the long-term goal of improving the survival rate,” says Professor Wolfgang Wick.
Gene mutation predicts improved outcome
Depending on their tissue composition, anaplastic gliomas are classified in different sub-groups which are assumed to have different prognoses. However, in this study, the previously distinct sub-groups of oligodendroglial tumors had an identical clinical course. With the aid of extensive molecular pathology studies of extirpated tumor tissue, the researchers identified a new prognosis factor called IDH1 mutation (gene mutation of isocitrate dehydrogenase). It is indicative, irrespective of the type of tissue of the anaplastic glioma and irrespective of treatment, of a better prognosis. The researchers proved that the already known prognosis factor “MGMT promoter methylation” is not predictive for chemotherapy, but did have prognostic value for chemotherapy as well as for radiation alone. “The results are relevant not only for clinical routine, but for current study designs of the large study networks EORTC and RTOG as well,” explained Professor Wick.
NOA-04 Randomized Phase III Trial of Sequential Radiochemotherapy of Anaplastic Glioma With Procarbazine, Lomustine, and Vincristine or Temozolomide. Wolfgang Wick, Christian Hartmann, Corinna Engel, Mandy Stoffels, Jörg Felsberg, Florian Stockhammer, Michael C. Sabel, Susanne Koeppen, Ralf Ketter, Richard Meyermann, Marion Rapp, Christof Meisner, Rolf D. Kortmann, Torsten Pietsch, Otmar D. Wiestler, Ulrike Ernemann, Michael Bamberg, Guido Reifenberger, Andreas von Deimling, and Michael Weller. Journal of Clinical Oncology, in press.
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