Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma

• Verfasst von: Gramatzki, Dorothee [VerfasserIn]
• Verfasst von: Vollmuth, Philipp [VerfasserIn]
• Verfasst von: Hentschel, Bettina [VerfasserIn]
• Verfasst von: Felsberg, Jörg [VerfasserIn]
• Verfasst von: Herrlinger, Ulrich [VerfasserIn]
• Verfasst von: Schmitz-Schackert, Gabriele [VerfasserIn]
• Verfasst von: Tonn, Jörg-Christian [VerfasserIn]
• Verfasst von: Westphal, Manfred [VerfasserIn]
• Verfasst von: Sabel, Michael [VerfasserIn]
• Verfasst von: Schlegel, Uwe [VerfasserIn]
• Verfasst von: Wick, Wolfgang [VerfasserIn]
• Verfasst von: Pietsch, Torsten [VerfasserIn]
• Verfasst von: Reifenberger, Guido [VerfasserIn]
• Verfasst von: Löffler, Markus [VerfasserIn]
• Verfasst von: Bendszus, Martin [VerfasserIn]
• Verfasst von: Weller, Michael [VerfasserIn]
• Titel: Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma
• Verf.angabe: Dorothee Gramatzki, MD, Philipp Kickingereder, MD, Bettina Hentschel, PhD, Jörg Felsberg, MD, Ulrich Herrlinger, MD, Schackert, MD, Jörg-Christian Tonn, MD, Manfred Westphal, MD, Michael Sabel, MD, Uwe Schlegel, MD, Wolfgang Wick, MD, Torsten Pietsch, MD, Guido Reifenberger, MD, Markus Loeffler, MD, Martin Bendszus, MD, Michael Weller, MD
• E-Jahr: 2017
• Jahr: March 15, 2017
• Umfang: 9 S.
• Teil: volume:88
• Teil: year:2017
• Teil: number:15
• Teil: pages:1422-1430
• Teil: extent:9
• Fussnoten: Gesehen am 18.08.2021
• Titel Quelle: Enthalten in: Neurology
• Ort Quelle: Philadelphia, Pa. : Wolters Kluwer, 1951
• Jahr Quelle: 2017
• Band/Heft Quelle: 88(2017), 15, Seite 1422-1430
• ISSN Quelle: 1526-632X
• URN: 10.1212/WNL.0000000000003809
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1572407174

Abstract

Objective: To explore an association with survival of modifying the current standard of care for patients with newly diagnosed glioblastoma of surgery followed by radiotherapy plus concurrent and 6 cycles of maintenance temozolomide chemotherapy (TMZ/RT → TMZ) by extending TMZ beyond 6 cycles. - Methods: The German Glioma Network cohort was screened for patients with newly diagnosed glioblastoma who received TMZ/RT → TMZ and completed ≥6 cycles of maintenance chemotherapy without progression. Associations of clinical patient characteristics, molecular markers, and residual tumor determined by magnetic resonance imaging after 6 cycles of TMZ with progression-free survival (PFS) and overall survival (OS) were analyzed with the log-rank test. Multivariate analyses using the Cox proportional hazards model were performed to assess associations of prolonged TMZ use with outcome. - Results: Sixty-one of 142 identified patients received at least 7 maintenance TMZ cycles (median 11, range 7-20). Patients with extended maintenance TMZ treatment had better PFS (20.5 months, 95% confidence interval [CI] 17.7-23.3, vs 17.2 months, 95% CI 10.2-24.2, p = 0.035) but not OS (32.6 months, 95% CI 28.9-36.4, vs 33.2 months, 95% CI 25.3-41.0, p = 0.126). However, there was no significant association of prolonged TMZ chemotherapy with PFS (hazard ratio [HR] = 0.8, 95% CI 0.4-1.6, p = 0.559) or OS (HR = 1.6, 95% CI 0.8-3.3, p = 0.218) adjusted for age, extent of resection, Karnofsky performance score, presence of residual tumor, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, or isocitrate dehydrogenase (IDH) mutation status. - Conclusion: These data may not support the practice of prolonging maintenance TMZ chemotherapy beyond 6 cycles. - Classification of evidence: This study provides Class III evidence that in patients with newly diagnosed glioblastoma, prolonged TMZ chemotherapy does not significantly increase PFS or OS.