The role of temozolomide in the management of patients with newly diagnosed anaplastic astrocytoma: a comparison of survival in the era prior to and following the availability of temozolomide

Abstract

Adding temozolomide (TMZ) to radiation for patients with newly-diagnosed anaplastic astrocytomas (AAs) is common clinical practice despite the lack of prospective studies demonstrating a survival advantage. Two retrospective studies, each with methodologic limitations, provide conflicting advice regarding treatment. This single-institution retrospective study was conducted to determine survival trends in patients with AA. All patients ≥18 years with newly-diagnosed AA treated at Johns Hopkins from 1995 to 2012 were included. As we incorporated TMZ into high-grade glioma treatment regimens in 2004, patients were divided into pre-2004 and post-2004 groups for analysis. Clinical, radiographic, and pathologic data were collected. Median overall survival (OS) was calculated using Kaplan–Meier estimates. A total of 196 patients were identified; 74 pre-2004 and 122 post-2004; mean age 47 ± 15 years; 57 % male; 87 % white, 69 % surgical debulking. Mean RT dose 5676 + 746 cGy; duration of concurrent chemoradiation 5.8 ± 0.8 weeks; and mean adjuvant chemotherapy 4.3 + 2.8 cycles. Baseline prognostic factors did not differ between groups. Chemotherapy was administered to 12 % of patients pre-2004 (TMZ = 1, procarbazine, lomustine and vincristine = 2, carmustine wafer = 6) and 94 % post-2004 (TMZ in all, p < 0.001). Median OS was 32 months (95 % CI 23–43). Survival was longer in the post-2004 cohort (37 mo, 24–64) than pre-2004 (27 mo, 19–40; HR 0.75, 0.53–1.06, p = 0.11). Multivariate analysis controlling for age, Karnofsky performance status, and extent of resection revealed a 36 % reduced risk of death (HR 0.64, 0.44–0.91, p = 0.015) in patients treated post-2004. This retrospective review found survival in newly diagnosed patients with AA improved with the addition of temozolomide to standard radiation. Until prospective randomized phase III data are available, these data support the practice of incorporating TMZ in the management of newly-diagnosed AA.

Cerebellar anaplastic astrocytoma in adult patients: 15 consecutive cases from a single institution and literature review

“…Median OS in a review published by Djalilian for 19 adult cAA patients was very similar -32 months. [7] OS in our control group was similar to the data published before: Strowd et al [26] demonstrated OS for AA in the temozolomide era as 36,7 months. For this comparison, it is noteworthy that both patients harboring additional supratentorial tumour (in case 1 AA, case 11 of unknown histology) had very short overall survival -9 and 9.3 months, respectively.…”

Gliomatosis Cerebri: Current Understanding and Controversies

“…Various studies have reported an OS of 18–35 months for grade II, 12–29 months for grade III and 9–36 months for grade IV GC ( 1 , 4 , 5 , 34 , 51 ). Even though these data are highly variable, contrast this to OS of 8–13 years in grade II gliomas ( 52 ), 37 months to 15 years for grade III gliomas ( 53 , 54 ), and 15–16 months in glioblastoma ( 55 , 56 ). It is quite clear that patients with GC fare much worse than patients with diffuse gliomas of corresponding grades.…”

In vitro anti‐tubulin effects of mebendazole and fenbendazole on canine glioma cells

“…The 2‐year survival rate was 26.5% with radiation therapy plus temozolomide and 10.3% with radiation therapy alone . Based on these findings, temozolomide along with surgical resection and radiation therapy became the standard of care for GB . Unfortunately, due to inherent resistance mechanisms in a subset of human patients, not all patients treated with temozolomide will experience a significantly more favourable outcome.…”