Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma.


OBJECTIVE: To explore an association with survival of modifying the current standard of care for patients with newly diagnosed glioblastoma of surgery followed by radiotherapy plus concurrent and 6 cycles of maintenance temozolomide chemotherapy (TMZ/RT --> TMZ) by extending TMZ beyond 6 cycles. METHODS: The German Glioma Network cohort was screened for patients with newly diagnosed glioblastoma who received TMZ/RT --> TMZ and completed >/=6 cycles of maintenance chemotherapy without progression. Associations of clinical patient characteristics, molecular markers, and residual tumor determined by magnetic resonance imaging after 6 cycles of TMZ with progression-free survival (PFS) and overall survival (OS) were analyzed with the log-rank test. Multivariate analyses using the Cox proportional hazards model were performed to assess associations of prolonged TMZ use with outcome. RESULTS: Sixty-one of 142 identified patients received at least 7 maintenance TMZ cycles (median 11, range 7-20). Patients with extended maintenance TMZ treatment had better PFS (20.5 months, 95% confidence interval [CI] 17.7-23.3, vs 17.2 months, 95% CI 10.2-24.2, p = 0.035) but not OS (32.6 months, 95% CI 28.9-36.4, vs 33.2 months, 95% CI 25.3-41.0, p = 0.126). However, there was no significant association of prolonged TMZ chemotherapy with PFS (hazard ratio [HR] = 0.8, 95% CI 0.4-1.6, p = 0.559) or OS (HR = 1.6, 95% CI 0.8-3.3, p = 0.218) adjusted for age, extent of resection, Karnofsky performance score, presence of residual tumor, O(6)-methylguanine DNA methyltransferase (MGMT) promoter methylation status, or isocitrate dehydrogenase (IDH) mutation status. CONCLUSION: These data may not support the practice of prolonging maintenance TMZ chemotherapy beyond 6 cycles. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in patients with newly diagnosed glioblastoma, prolonged TMZ chemotherapy does not significantly increase PFS or OS.

PubMed ID: 28298550

Projects: GGN - German Glioma Network

Publication type: Journal article

Journal: Neurology

Human Diseases: Brain glioblastoma multiforme

Citation: Neurology. 2017 Apr 11;88(15):1422-1430. doi: 10.1212/WNL.0000000000003809. Epub 2017 Mar 15.

Date Published: 11th Apr 2017

Registered Mode: by PubMed ID

Authors: D. Gramatzki, P. Kickingereder, B. Hentschel, J. Felsberg, U. Herrlinger, G. Schackert, J. C. Tonn, M. Westphal, M. Sabel, U. Schlegel, W. Wick, T. Pietsch, G. Reifenberger, M. Loeffler, M. Bendszus, M. Weller

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Created: 6th May 2019 at 12:45

Last updated: 7th Dec 2021 at 17:58

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