Combined Chemo-Radiation Extends Survival in Patients with Anaplastic Oligodendroglial Tumors, Particularly Those with a Specific Chromosomal Mutation
A Phase III study conducted by the European Organisation for Research and Treatment of Cancer (EORTC) has shown that giving combination chemotherapy after standard radiation therapy delayed tumor growth and extended the lives of patients with anaplastic oligodendroglial tumors, a hard-to-treat form of brain cancer. A sub-analysis of the study showed the survival benefit of chemotherapy may be limited to patients whose tumors contained specific deletions of genetic material in chromosomes 1 and 19 (1p/19q co-deletions).
“From this trial, it’s clear that combining chemotherapy and radiation can significantly improve survival for certain patients,” explained lead author Martin Van Den Bent, MD, Professor of Neuro-Oncology at ErasmusMC – Daniel den Hoed Cancer Center, Rotterdam, the Netherlands. “Not only do we now have a better treatment – we also have a genetic marker that can help us determine which patients will benefit, allowing us to personalize treatment for this challenging disease.”
The 368 patients enrolled in this study had newly diagnosed, previously untreated anaplastic oligodendroglial tumors. They were randomly assigned to receive either radiation therapy alone or radiation followed by six cycles of chemotherapy with the drugs procarbazine, CCNU and vincristine, a regimen known as PCV. Currently, most patients with the disease are treated with either chemotherapy or radiation, but not both.
Progression-free survival was 24.3 months in the radiation/PCV group and 13.2 months in the radiation-only group. Overall survival was 42.3 months in the radiation/PVC group and 30.6 months in the radiation-only group.
When examined by genetic subtype, researchers found that the benefit of PCV and radiation was restricted to a subset of 80 patients known to have 1p/19q co-deletions. For these patients, afflicted with a lethal brain cancer, treatment with RT/PCV reduced their risk of dying by 44% compared to patients administered RT alone. Survival in this group after radiation was 9 years, and was still not reached in the radiation/PCV group after follow-up of almost 12 years. Among 236 patients without these co-deletions, overall survival was not statistically different between the treatment groups (25 months for the radiation/PCV group versus 22 months for radiation alone).
Over the years, the EORTC has set the world wide standard of care for a variety of cancers including grade IV brain tumors (glioblastoma). The present study carried out by the EORTC Brain Tumor Group is the result of an ongoing effort dating back 17 years, and is an example of the crucial role academic network organizations play in improving the care for these difficult to study cancer types.
This study complements similar research also presented at this year’s ASCO Annual Meeting and conducted by North American investigators. A Phase III study led by Dr Cairncross (Abstract #2008b) found that giving both PCV and radiation therapy (in this, case, with chemotherapy preceding radiation) led to comparable improvements in survival for oligodendroglial tumor patients with 1p/19q co-deletions, but not for patients without the mutation.
About the EORTC
The EORTC is a unique organization – a vibrant example of the fact that academic science and research know no national boundaries. Established in 1962, the EORTC is a non-profit European research organization operating as an international association under Belgian law.
The EORTC currently links a network of more than 2,500 pre-clinical scientists and oncologists in more than 300 hospitals in over 30 countries. It encompasses all aspects of cancer research, from translational research and new drug development to large phase III clinical trials and meta-analyses.
The 170 members of the EORTC Headquarters staff handle some 6,000 new patients enrolled each year in cancer clinical trials, approximately 30 protocols that are permanently open to patient entry, over 50,000 patients who are in follow-up, and a database of more than 180,000 patients.
The ultimate goal of the EORTC is to improve the future of cancer therapy by developing new agents and innovative approaches and to test more effective treatment strategies using commercially available drugs, or surgery and radiotherapy.