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In some with grade 3 brain cancer, adding PCV chemotherapy regimen to radiation showed better survival outcomes than another type of chemotherapy, but safety should be considered.
Patients newly diagnosed with IDH-mutant 1p/19q-codeleted grade 3 oligodendroglioma, a rare type of brain cancer, demonstrated better survival outcomes when treated with one particular chemotherapy regimen plus radiation therapy compared with temozolomide (TMZ) and radiation.
Oligodendroglioma is a tumor that forms in the brain or spinal cord. When receiving a diagnosis for this cancer type, it requires finding an IDH mutation and a particular change in the chromosomes in the tumor cells, according to the National Cancer Institute. These specific changes are known as a 1p/19q-codeletion. When the cancer is considered grade 3, these tumors are known to be fast-growing.
In a study published in the Journal of Clinical Oncology, researchers evaluated 305 patients newly diagnosed with IDH-mutant 1p/19q-codeleted grade 3 oligodendroglioma in a cohort called POLA. Patients were placed into two groups to either receive a chemotherapy regimen of procarbazine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) and vincristine (PCV) plus radiation, or TMZ plus radiation. The PCV plus radiation group included 207 patients and the TMZ plus radiation group included 98 patients.
The median duration of follow-up from surgery was 78.4 months for patients in both treatment groups, according to the study. Specifically, the duration of follow-up from surgery was 77.6 months in the PCV plus radiation group and 86.3 months in the TMZ plus radiation group.
Researchers from the study noted that 111 of 305 patients experienced a relapse (disease worsening after a period of improvement) and 64 patients died.
“In this national observational study, we found that first-line treatment with PCV [plus radiation] was associated with better long-term [overall survival] and [progression]ree survival] compared with TMZ [plus radiation] in patients with newly diagnosed [IDH-mutant 1p/19q-codeleted grade 3 oligodendroglioma],” researchers wrote in the study.
Among patients from both treatment groups, the overall survival (OS; time patients live, regardless of cancer status) at five and 10 years were 84% and 69%, respectively, the researchers stated in the study.
Regarding progression-free survival (PFS; time patients live without signs of disease worsening or spreading), the PFS at five and 10 years was 67% and 55%, respectively.
Of note, researchers found that patients treated in the PCV plus radiation group showed better OS versus patients who received TMZ plus radiation. At five years in the PCV plus radiation group, the OS was 89% versus an OS of 75% in the TMZ plus radiation group, the study showed. The median OS was also not reached in the PCV plus radiation group, meaning more patients from this group remained alive longer than predicted. In the TMZ plus radiation group, the median OS was 140 months, the researchers established.
The study also determined that the PFS in patients from the PCV plus radiation group showed improvements compared with patients from the TMZ plus radiation group. At five years, the PFS was 75% versus 51% in the PCV and TMZ groups, respectively, researchers noted. At 10 years, the PFS was 67% versus 35%.
Among patients in the PCV group, the median PFS was not reached and was 60 months in patients from the TMZ group, the study stated.
Although patients in the PCV group showed improved OS and PFS outcomes, the researchers emphasized that the side effects associated with these treatments are important to consider.
They noted that based on previous trials, including the EORTC 26951 trial published in the Journal of Clinical Oncology, “38% of patients could not complete the PCV regimen due to hematologic (blood) or nonhematologic toxicity,” they wrote.
In the POLA cohort, researchers also observed a similar number of chemotherapy discontinuations in patients. Specifically, 36% of patients from the PCV group did not receive six chemotherapy cycles, the noted.
“Survival Outcomes Associated With First-Line Procarbazine, CCNU, and Vincristine or Temozolomide in Combination With Radiotherapy in IDH-Mutant 1p/19q-Codeleted Grade 3 Oligodendroglioma” by Dr. Salah O. Kacimi, et al., Journal of Clinical Oncology.
However, the safety profile for TMZ was associated with more favorable outcomes, the researchers stated. A previous trial, CATNON, published in Lancet Oncology demonstrated that 15% of patients who received presurgical TMZ experienced grade 3 or 4 (severe to life-threatening) hematologic side effects.
“Despite these results in support of the use of PCV [plus] RT over TMZ [plus] RT, the safety profile of PCV remains a challenge,” the researchers wrote.
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