; Tonn, Jörg C. ; Schlegel, Uwe ; Marosi, Christine ; Goldbrunner, Roland ; Stupp, Roger ; Homicsko, Krisztian ; Pichler, Josef ; Nikkhah, Guido ; Meixensberger, Jürgen ; Vajkoczy, Peter ; Kollias, Spyros ; Hüsing, Johannes ; Reifenberger, Guido ; Wick, Wolfgang | Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Clinical Cancer Research | ||||
| Publisher: | AMER ASSOC CANCER RESEARCH | ||||
| Place of Publication: | PHILADELPHIA | ||||
| Volume: | 21 | ||||
| Number of Issue or Book Chapter: | 9 | ||||
| Page Range: | pp. 2057-2064 | ||||
| Date: | 2015 | ||||
| Institutions: | Medicine > Lehrstuhl für Neurologie | ||||
| Identification Number: |
| ||||
| Keywords: | NEWLY-DIAGNOSED GLIOBLASTOMA; PHASE-II TRIAL; SINGLE-AGENT BEVACIZUMAB; HIGH-GRADE GLIOMA; RECURRENT GLIOBLASTOMA; MALIGNANT GLIOMA; RANDOMIZED-TRIAL; CLINICAL-TRIAL; LOMUSTINE; RADIOTHERAPY; | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 60474 |
Abstract
Purpose: Rechallenge with temozolomide (TMZ) at first progression of glioblastoma after temozolomide chemoradiotherapy (TMZ/RT -> TMZ) has been studied in retrospective and single-arm prospective studies, applying temozolomide continuously or using 7/14 or 21/28 days schedules. The DIRECTOR trial sought to show superiority of the 7/14 regimen. Experimental Design: Patients with glioblastoma at ...

Abstract
Purpose: Rechallenge with temozolomide (TMZ) at first progression of glioblastoma after temozolomide chemoradiotherapy (TMZ/RT -> TMZ) has been studied in retrospective and single-arm prospective studies, applying temozolomide continuously or using 7/14 or 21/28 days schedules. The DIRECTOR trial sought to show superiority of the 7/14 regimen. Experimental Design: Patients with glioblastoma at first progression after TMZ/RT -> TMZ and at least two maintenance temozolomide cycles were randomized to Arm A [one week on (120 mg/m(2) per day)/one week off] or Arm B [3 weeks on (80 mg/m(2) per day)/one week off]. The primary endpoint was median time-to-treatment failure (TTF) defined as progression, premature temozolomide discontinuation for toxicity, or death from any cause. O-6-methylguanine DNA methyltransferase (MGMT) promoter methylation was prospectively assessed by methylation-specific PCR. Results: Because of withdrawal of support, the trial was prematurely closed to accrual after 105 patients. There was a similar outcome in both arms for median TTF [A: 1.8 months; 95% confidence intervals (CI), 1.8-3.2 vs. B: 2.0 months; 95% CI, 1.8-3.5] and overall survival [A: 9.8 months (95% CI, 6.7-13.0) vs. B: 10.6 months (95% CI, 8.1-11.6)]. Median TTF in patients with MGMT-methylated tumors was 3.2 months (95% CI, 1.87.4) versus 1.8 months (95% CI, 1.8-2) in MGMT-unmethylated glioblastoma. Progression-free survival rates at 6 months (PFS-6) were 39.7% with versus 6.9% without MGMT promoter methylation. Conclusions: Temozolomide rechallenge is a treatment option for MGMT promoter-methylated recurrent glioblastoma. Alternative strategies need to be considered for patients with progressive glioblastoma without MGMT promoter methylation. (C) 2015 AACR.
Metadata last modified: 19 Dec 2024 07:34
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