In:
Neuro-Oncology, Oxford University Press (OUP), Vol. 25, No. Supplement_2 ( 2023-09-08), p. ii4-ii4
Abstract:
Patients with IDH-mutant, 1p/19q codeleted, grade 3 oligodendroglioma (Olig-3) derive benefit from the addition of alkylating agent chemotherapy to radiotherapy. However, to date, the choice between Procarbazine, Lomustine, and Vincristine (PCV) or Temozolomide (TMZ) as an optimal chemotherapy regimen for these patients remains unclear due to the lack of randomized clinical trial data comparing the two regimens. MATERIAL AND METHODS The objective was to assess the survival outcomes associated with first-line radiotherapy and PCV compared to radiotherapy and TMZ in patients with IDH-mutant, 1p/19q codeleted Olig-3 (WHO 2021). We included patients with histologically-proven IDH-mutant, 1p/19q codeleted Olig-3 from a large prospective French network cohort (POLA). The overall survival (OS) from surgery date was computed using Kaplan-Meier methods and Cox proportional hazards regression model. RESULTS A total of 306 patients with IDH-mutant, 1p/19q codeleted Olig-3 treated with radiotherapy and chemotherapy between 2008 and 2022 were included. In all, 67.6% of patients (n=207, median age at diagnosis 49.3y [IQR: 40.4-58.7]) were treated with PCV and 32.4% with TMZ (n=99, 50.3y [IQR: 43.8-61.2] ) as first-line chemotherapy. Baseline characteristics were comparable between patients from both groups. The median follow-up duration was 78.4 months (IQR: 44.4-103.0). Median OS was not reached (95% CI: NR-NR) and 140 months (95% CI: 110-NR) in the PCV and TMZ groups, respectively (log rank test for OS, P=0.0023). On univariate analysis, there was a significant difference in both 5-year (PCV: 89%, 95% CI: 85-94 vs TMZ: 75%, 95% CI: 67-84; P = 0.0014) and 10-year OS (PCV: 73%, 95% CI: 62-85 vs TMZ: 60%, 95%CI: 49-73; P = 0.003) in favor of PCV. In the adjusted analysis for age, extent of resection, gender and Karnofsky performance scale (n=288), a significant OS difference between TMZ and PCV was found in the Cox proportional hazards regression model (TMZ vs. PCV HR 2.01, 95% CI: 1.16-3.50, P=0.013). CONCLUSION In the POLA cohort, among patients with IDH-mutant, 1p/19q codeleted Olig-3 receiving first-line radiotherapy combined with chemotherapy, treatment with PCV was associated with better survival compared to TMZ in both univariate and adjusted analyses. The small sample size and event rate especially in TMZ group warrants further validation. However, these results provide preliminary data on survival outcomes associated with first-line chemotherapy with PCV or TMZ in patients with IDH-mutant, 1p/19q codeleted Olig-3.
Type of Medium:
Online Resource
ISSN:
1522-8517
,
1523-5866
DOI:
10.1093/neuonc/noad137.010
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2023
detail.hit.zdb_id:
2094060-9
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