TEMOBIC: Phase II Trial of Neoadjuvant Chemotherapy for Unresectable Anaplastic Gliomas: An ANOCEF Study
Mené sur 55 patients atteints d'un gliome anaplasique non résécable (âge médian : 53,1 ans), cet essai de phase II évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité d'une chimiothérapie néoadjuvante à base de BCNU (carmustine) et de témozolomide
Background :The optimal treatment for unresectable large anaplastic gliomas remains debated. Methods : Adult patients with histologically proven unresectable anaplastic oligodendroglioma or mixed gliomas (WHO2007) were eligible. Treatment consisted of BCNU (150 mg/m2) and temozolomide (110 mg/m2 for 5 days) every 6 weeks for 6 cycles before radiotherapy. Results : Between December 2005 and December 2009, 55 patients (median age of 53.1 years; range: 20.5–70.2) were included. Forty percent of patients presented with wild‐type IDH1 gliomas and 30% presented with methylated MGMT promoter. Median progression‐free survival (PFS), centralized PFS, and overall survival (OS) were 16.6 (95% CI: 12.8‐20.3), 15.4 (95% CI:10.0‐20.8), and 25.4 (95% CI: 17.5‐33.2) months, respectively. Complete and partial responses under chemotherapy were observed for 28.3% and 17% of patients, respectively. Radiotherapy completion was achieved for 75% of patients. Preservation of functional status and self‐care capability (KPS ≥70) were preserved until disease progression for 69% of patients. Grade ≥3 toxicities were reported for 52% of patients, and 3 deaths were related to treatment. By multivariate analyses including age and KPS, IDH mutation was associated with better prognostic for both PFS and OS while MGMTpromoteur methylation was associated with better OS. Conclusion : The association of BCNU and temozolomide upfront is active for patients with unresectable anaplastic gliomas, but toxicity limits its use.
The Oncologist 2021