Several key papers regarding advances in brain tumors have been published in 2016 and 2017, and all are practice changing. A pivotal European/Canadian phase III trial on glioblastoma (GBM) in elderly patients (1) has reported a survival advantage after surgery for the combination of radiotherapy and temozolomide (TMZ) as compared with radiotherapy alone, and this was particularly evident in patients with MGMT methylation. Thus, the standard treatment for GBM is the same for both younger and elderly patients who are in good neurological conditions. Two other phase III trials in high risk low grade gliomas (2,3) has demonstrated on one hand that radiotherapy followed by PCV chemotherapy is superior over radiotherapy alone, and on the other hand initial chemotherapy with TMZ is of the same value of radiotherapy alone. The recent update of WHO classification of gliomas (4) has recognized the tremendous prognostic importance of the presence of IDH1/2 mutations, that appear to be stronger than the conventional grading of malignancy.
Keypoints:
- Chemoradiation in glioblastoma of elderly
- Best initial treatment in high risk low grade gliomas
- New WHO classification 2016 of Brain Tumors
References:
1. Perry JR, Laperriere N, O'Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, Nishikawa R, Cairncross JG, Roa W, Osoba D, Rossiter JP, Sahgal A, Hirte H, Laigle-Donadey F, Franceschi E, Chinot O, Golfinopoulos V, Fariselli L, Wick A, Feuvret L, Back M, Tills M, Winch C, Baumert BG, Wick W, Ding K, Mason WP; Trial Investigators. Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma. N Engl J Med. 2017 Mar 16;376(11):1027-1037. doi:10.1056/NEJMoa1611977. PubMed PMID: 28296618.
2. Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr. Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma. N Engl J Med. 2016 Apr 7;374(14):1344-55. doi:10.1056/NEJMoa1500925. PubMed PMID:27050206; PubMed Central PMCID: PMC5170873.
3. Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016 Nov;17(11):1521-1532. doi:10.1016/S1470-2045(16)30313-8. Epub 2016 Sep 27. PubMed PMID: 27686946; PubMed Central PMCID: PMC5124Wahl M, Phillips JJ, Molinaro AM, Lin Y, Perry A, Haas-Kogan DA, Costello JF,
4. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016 Jun;131(6):803-20. doi: 10.1007/s00401-016-1545-1. Epub 2016 May 9. Review. PubMed PMID: 27157931.