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New Approach for the Treatment of Malignant Brain Tumors
October 01, 2009Chemotherapy alone is just as effective as radiation / New positive prognostic factor found
Initial chemotherapy alone after surgery is just as successful as initial radiation therapy for patients from whom a very malignant brain tumor (anaplastic glioma) was removed. With this treatment, the patients survive on average > 30 months without a recurrence. A study conducted by the Neurooncology Working Group of the German Cancer Society led by researchers from Heidelberg and Zürich showed that patients in primary therapy benefit to the same extent from chemotherapy alone as from radiation alone.
In addition, the Working Group headed by Professor Dr. Wolfgang Wick, Medical Director of the Department of Neurooncology at Heidelberg University Hospital and Head of the Neurooncology Unit at the DKFZ, Professor Dr. Michael Weller, Chairman of the Department of Neurology at the University Hospital Zurich, and Prof. Andreas von Deimling, Medical Director of the Department of Neuropathology at Heidelberg University Hospital and Head of the Neuropathology Unit at the DKFZ, identified a new factor that is indicative of a positive prognosis - regardless of the form of treatment. The results of the study were published in the Journal of Clinical Oncology.
In Germany, around 4,500 people a year develop a glioma, a malignant brain tumor. Some 5 percent of primary brain tumors are what are known as anaplastic gliomas. They respond to treatment somewhat better than most other malignant brain tumors. The mean survival time in the study was > 80 months. As the tumors can branch out widely into the surrounding tissue, they cannot be completely removed. The subsequent therapy in the form of combined radiochemotherapy (radiation and chemotherapy) is the current standard treatment, but it is associated with a risk of long-term toxicity to healthy brain tissue, causing the patient to lose cognitive abilities.
Primary chemotherapy as an equivalent treatment option
Two studies recently conducted by the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) have shown that combined radiochemotherapy according to current standard practice does not yield better therapy results than radiotherapy alone. The NOA (Neurooncology Working Group) study has now also proven that chemotherapy alone after surgical removal of the tumor has an equivalent result. "This additional treatment option facilitates the further development of the treatment plan in new combinations with the long-term goal of improving the survival rate," says Professor Wolfgang Wick.
Gene mutation predicts improved outcome
Depending on their tissue composition, anaplastic gliomas are classified in different sub-groups which are assumed to have different prognoses. However, in this study, the previously distinct sub-groups of oligodendroglial tumors had an identical clinical course. With the aid of extensive molecular pathology studies of extirpated tumor tissue, the researchers identified a new prognosis factor called IDH1 mutation (gene mutation of isocitrate dehydrogenase). It is indicative, irrespective of the type of tissue of the anaplastic glioma and irrespective of treatment, of a better prognosis. The researchers proved that the already known prognosis factor "MGMT promoter methylation" is not predictive for chemotherapy, but did have prognostic value for chemotherapy as well as for radiation alone. "The results are relevant not only for clinical routine, but for current study designs of the large study networks EORTC and RTOG as well," explained Professor Wick.
Reference:
NOA-04 Randomized Phase III Trial of Sequential Radiochemotherapy of Anaplastic Glioma With Procarbazine, Lomustine, and Vincristine or Temozolomide. Wolfgang Wick, Christian Hartmann, Corinna Engel, Mandy Stoffels, Jörg Felsberg, Florian Stockhammer, Michael C. Sabel, Susanne Koeppen, Ralf Ketter, Richard Meyermann, Marion Rapp, Christof Meisner, Rolf D. Kortmann, Torsten Pietsch, Otmar D. Wiestler, Ulrike Ernemann, Michael Bamberg, Guido Reifenberger, Andreas von Deimling, and Michael Weller. Journal of Clinical Oncology, in press.
More Information about the Department of Neurooncology on the Internet:
http://www.klinikum.uni-heidelberg.de/index.php?id=105540&L=en
Heidelberg University Hospital
In Germany, around 4,500 people a year develop a glioma, a malignant brain tumor. Some 5 percent of primary brain tumors are what are known as anaplastic gliomas. They respond to treatment somewhat better than most other malignant brain tumors. The mean survival time in the study was > 80 months. As the tumors can branch out widely into the surrounding tissue, they cannot be completely removed. The subsequent therapy in the form of combined radiochemotherapy (radiation and chemotherapy) is the current standard treatment, but it is associated with a risk of long-term toxicity to healthy brain tissue, causing the patient to lose cognitive abilities.
Primary chemotherapy as an equivalent treatment option
Two studies recently conducted by the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) have shown that combined radiochemotherapy according to current standard practice does not yield better therapy results than radiotherapy alone. The NOA (Neurooncology Working Group) study has now also proven that chemotherapy alone after surgical removal of the tumor has an equivalent result. "This additional treatment option facilitates the further development of the treatment plan in new combinations with the long-term goal of improving the survival rate," says Professor Wolfgang Wick.
Gene mutation predicts improved outcome
Depending on their tissue composition, anaplastic gliomas are classified in different sub-groups which are assumed to have different prognoses. However, in this study, the previously distinct sub-groups of oligodendroglial tumors had an identical clinical course. With the aid of extensive molecular pathology studies of extirpated tumor tissue, the researchers identified a new prognosis factor called IDH1 mutation (gene mutation of isocitrate dehydrogenase). It is indicative, irrespective of the type of tissue of the anaplastic glioma and irrespective of treatment, of a better prognosis. The researchers proved that the already known prognosis factor "MGMT promoter methylation" is not predictive for chemotherapy, but did have prognostic value for chemotherapy as well as for radiation alone. "The results are relevant not only for clinical routine, but for current study designs of the large study networks EORTC and RTOG as well," explained Professor Wick.
Reference:
NOA-04 Randomized Phase III Trial of Sequential Radiochemotherapy of Anaplastic Glioma With Procarbazine, Lomustine, and Vincristine or Temozolomide. Wolfgang Wick, Christian Hartmann, Corinna Engel, Mandy Stoffels, Jörg Felsberg, Florian Stockhammer, Michael C. Sabel, Susanne Koeppen, Ralf Ketter, Richard Meyermann, Marion Rapp, Christof Meisner, Rolf D. Kortmann, Torsten Pietsch, Otmar D. Wiestler, Ulrike Ernemann, Michael Bamberg, Guido Reifenberger, Andreas von Deimling, and Michael Weller. Journal of Clinical Oncology, in press.
More Information about the Department of Neurooncology on the Internet:
http://www.klinikum.uni-heidelberg.de/index.php?id=105540&L=en
Heidelberg University Hospital
Chemotherapy Current Events and Chemotherapy News RSSFertility procedures need not delay breast cancer treatment for younger women
A new study published in the November issue of the Journal of the American College of Surgeons shows that breast cancer patients under 40 years old who undergo fertility preservation do not face a significant delay in the treatment of their disease when their care is coordinated in a timely fashion.
Drugs to treat anemia in cancer patients linked to thromboembolism
Medications frequently given to cancer patients to reduce their risk of anemia are associated with an increased risk of deep vein thrombosis or pulmonary embolism, according to new research led by Dawn Hershman, M.D, M.S., co-director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center.
For young boys with cancer, testicular tissue banking may be option to preserve fertility
For parents of children with cancer, the hopeful news is that pediatric survival rates have steadily improved for decades. Among the bad news-treatments that enable survival often cause infertility.
FDA approved leukemia drugs shows promise in ovarian cancer cells
The drug Sprycel, approved for use by the U.S. Food and Drug Administration in patients with chronic myeloid leukemia, significantly inhibited the growth and invasiveness of ovarian cancer cells and also promoted their death, a study by researchers with UCLA's Jonsson Comprehensive Cancer Center found.
1930s drug slows tumor growth
Drugs sometimes have beneficial side effects. A glaucoma treatment causes luscious eyelashes. A blood pressure drug also aids those with a rare genetic disease.
First use of antibody and stem cell transplantation to successfully treat advanced leukemia
For the first time, researchers at Fred Hutchinson Cancer Research Center have reported the use of a radiolabeled antibody to deliver targeted doses of radiation, followed by a stem cell transplant, to successfully treat a group of leukemia and pre-leukemia patients for whom there previously had been no other curative treatment options.
New Synthetic Molecules Trigger Immune Response to HIV and Prostate Cancer
Researchers at Yale University have developed synthetic molecules capable of enhancing the body's immune response to HIV and HIV-infected cells, as well as to prostate cancer cells. Their findings, published online in the Journal of the American Chemical Society, could lead to novel therapeutic approaches for these diseases.
Chemo-radiation before prostate removal may prevent cancer recurrence
Researchers in the Oregon Health & Science University Knight Cancer Institute and the Portland Veterans Affairs Medical Center have found a combination of radiation therapy and chemotherapy given before prostate removal is safe and may have the potential to reduce cancer recurrence and improve patient survival.
PMH finding may help some tonsil cancer patients avoid chemotherapy
Clinical researchers at Princess Margaret Hospital (PMH) have confirmed that patients with oropharyngeal squamous cell cancer ("tonsil cancer") harbour a common type of human papilloma virus (HPV16), but also that such cancers are very sensitive to radiation.
Study of concurrent radiotherapy, chemotherapy shows promise in small cell lung cancer
Treating limited stage small cell lung cancer(LSCL) with a combination of accelerated high-dose radiotherapy and chemotherapy has shown encouraging results.
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