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- Title
Limited efficacy of temozolomide alone for astrocytoma, IDH-mutant, CNS WHO grades 2 or 3.
- Authors
Weller, Jonathan; Katzendobler, Sophie; Blobner, Jens; Thiele, Frederic; Becker, Hannes; Quach, Stefanie; Egensperger, Rupert; Niyazi, Maximilian; Suchorska, Bogdana; Thon, Niklas; Weller, Michael; Tonn, Joerg-Christian
- Abstract
Purpose: The role of temozolomide chemotherapy alone in isocitrate dehydrogenase (IDH)-mutant astrocytomas has not been conclusively determined. Radiotherapy might be superior to temozolomide. Recent studies have linked temozolomide with induction of hypermutation and poor clinical course in some IDH-mutant gliomas. Methods: In this retrospective study, 183 patients with astrocytoma, IDH-mutant, CNS WHO grade 2 or 3 and diagnosed between 2001 and 2019 were included. Patients initially monitored by wait-and-scan strategies or treated with radiotherapy or temozolomide alone were studied. Patient data were correlated with outcome. Matched pair and subgroup analyses were conducted. Results: Radiotherapy was associated with longer progression-free survival than temozolomide (6.2 vs 3.4 years, p = 0.02) and wait-and-scan strategies (6.2 vs 4 years, p = 0.03). Patients treated with radiotherapy lived longer than patients treated with temozolomide (14.4 vs 10.7 years, p = 0.02). Survival was longer in the wait-and-scan cohort than in the temozolomide cohort (not reached vs 10.7 years, p < 0.01). Patients from the wait-and-scan cohort receiving temozolomide at first progression had significantly shorter survival times than patients treated with any other therapy at first progression (p < 0.01). Post-surgical T2 tumor volume, contrast enhancement on MRI and WHO grade were associated with overall survival in univariate analyses (p < 0.01). Conclusion: The results suggest superiority of radiotherapy over temozolomide and wait-and-scan strategies regarding progression-free survival and superiority of radiotherapy over temozolomide regarding overall survival. Our results are consistent with the notion that early temozolomide might compromise outcome in some patients.
- Subjects
TEMOZOLOMIDE; ASTROCYTOMAS; ISOCITRATE dehydrogenase; PROGRESSION-free survival; SURVIVAL analysis (Biometry)
- Publication
Journal of Neuro-Oncology, 2022, Vol 160, Issue 1, p149
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-022-04128-y