Phase III randomized study of radiation and temozolomide versus radiation and nitrosourea therapy for anaplastic astrocytoma: results of NRG Oncology RTOG 9813.

Academic Article

Abstract

  • Background: The primary objective of this study was to compare the overall survival (OS) of patients with anaplastic astrocytoma (AA) treated with radiotherapy (RT) and either temozolomide (TMZ) or a nitrosourea (NU). Secondary endpoints were time to tumor progression (TTP), toxicity, and the effect of IDH1 mutation status on clinical outcome. Methods: Eligible patients with centrally reviewed, histologically confirmed, newly diagnosed AA were randomized to receive either RT+TMZ (n = 97) or RT+NU (n = 99). The study closed early because the target accrual rate was not met. Results: Median follow-up time for patients still alive was 10.1 years (1.9-12.6 y); 66% of the patients died. Median survival time was 3.9 years in the RT/TMZ arm (95% CI, 3.0-7.0) and 3.8 years in the RT/NU arm (95% CI, 2.2-7.0), corresponding to a hazard ratio (HR) of 0.94 (P = .36; 95% CI, 0.67-1.32). The differences in progression-free survival (PFS) and TTP between the 2 arms were not statistically significant. Patients in the RT+NU arm experienced more grade ≥3 toxicity (75.8% vs 47.9%, P < .001), mainly related to myelosuppression. Of the 196 patients, 111 were tested for IDH1-R132H status (60 RT+TMZ and 51 RT+NU). Fifty-four patients were IDH negative and 49 were IDH positive with a better OS in IDH-positive patients (median survival time 7.9 vs 2.8 y; P = .004, HR = 0.50; 95% CI, 0.31-0.81). Conclusions: RT+TMZ did not appear to significantly improve OS or TTP for AA compared with RT+ NU. RT+TMZ was better tolerated. IDH1-R132H mutation was associated with longer survival.
  • Authors

    Published In

  • Neuro-Oncology  Journal
  • Keywords

  • anaplastic astrocytoma, nitrosourea, radiotherapy, temozolomide, Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Agents, Alkylating, Astrocytoma, Biomarkers, Tumor, Brain Neoplasms, Chemoradiotherapy, Dacarbazine, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Staging, Nitrosourea Compounds, Prognosis, Prospective Studies, Survival Rate, Temozolomide, Young Adult
  • Digital Object Identifier (doi)

    Pubmed Id

  • 17463250
  • Author List

  • Chang S; Zhang P; Cairncross JG; Gilbert MR; Bahary J-P; Dolinskas CA; Chakravarti A; Aldape KD; Bell EH; Schiff D
  • Start Page

  • 252
  • End Page

  • 258
  • Volume

  • 19
  • Issue

  • 2