Difference between revisions of "Low-grade glioma"

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m (Text replacement - "==[https://www.nccn.org/ NCCN]==" to "==NCCN==")
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[[#top|Back to Top]]
 
[[#top|Back to Top]]
 
</div>
 
</div>
{| class="wikitable" style="text-align:center; width:50%;"
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{{#lst:Editorial board transclusions|neuro}}
!colspan="2" align="center" style="color:white; font-size:125%; background-color:#08519c"|'''Section editor'''
 
|-
 
|style="background-color:#F0F0F0"|[[File:SeemaNagpal.jpg|frameless|upright=0.3|center]]
 
|<big>[[User:Seemanagpal|Seema Nagpal, MD]]<br>Stanford University<br>Palo Alto, CA</big>
 
|-
 
|}
 
 
''Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit [[Low-grade glioma - null regimens|this page]]. If you still can't find it, please let us know so we can add it!''<br>
 
''Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit [[Low-grade glioma - null regimens|this page]]. If you still can't find it, please let us know so we can add it!''<br>
 
<big>'''Note: pediatric regimens have been moved to a dedicated page:
 
<big>'''Note: pediatric regimens have been moved to a dedicated page:
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{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
 
=Guidelines=
 
=Guidelines=
 +
'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
 
==EANO==
 
==EANO==
 
*[https://doi.org/10.1016/S1470-2045(17)30194-8 European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas (2017)] [https://pubmed.ncbi.nlm.nih.gov/28483413/ PubMed]
 
*[https://doi.org/10.1016/S1470-2045(17)30194-8 European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas (2017)] [https://pubmed.ncbi.nlm.nih.gov/28483413/ PubMed]
*[https://doi.org/10.1016/S1470-2045(17)30345-5 European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma (2017)] [https://pubmed.ncbi.nlm.nih.gov/28593859 PubMed]
+
*[https://doi.org/10.1016/S1470-2045(17)30345-5 European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma (2017)] [https://pubmed.ncbi.nlm.nih.gov/28593859/ PubMed]
==[https://www.nccn.org/ NCCN]==
+
==NCCN==
*[https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf NCCN Guidelines - Central Nervous System Cancers]
+
*''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1425 NCCN Guidelines - Central Nervous System Cancers].''
 +
 
 
=Adjuvant therapy=
 
=Adjuvant therapy=
 
==PCV {{#subobject:768bb0|Regimen=1}}==
 
==PCV {{#subobject:768bb0|Regimen=1}}==
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|style="background-color:#1a9851"|Phase 3 (E-esc)
 
|style="background-color:#1a9851"|Phase 3 (E-esc)
 
|[[Low-grade_glioma_-_null_regimens#Observation|Observation]]
 
|[[Low-grade_glioma_-_null_regimens#Observation|Observation]]
|style="background-color:#1a9850"|Superior OS<sup>1</sup>
+
|style="background-color:#1a9850"|Superior OS<sup>1</sup> (primary endpoint)<br>Median OS: 13.3 vs 7.8 y<br>(HR 0.59)
 
|-
 
|-
 
|}
 
|}
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<div class="toccolours" style="background-color:#cbd5e8">
 
<div class="toccolours" style="background-color:#cbd5e8">
 
====Preceding treatment====
 
====Preceding treatment====
*[[#Radiation_therapy|RT]] x 54 Gy
+
*Definitive [[#Radiation_therapy|RT]] x 5400 cGy
 
</div>
 
</div>
 
<div class="toccolours" style="background-color:#b3e2cd">
 
<div class="toccolours" style="background-color:#b3e2cd">
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'''8-week cycle for 6 cycles'''
 
'''8-week cycle for 6 cycles'''
 
</div></div>
 
</div></div>
 +
 
===References===
 
===References===
# '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article]  '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558 PubMed] NCT00003375
+
# '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article]  '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558/ PubMed] [https://clinicaltrials.gov/study/NCT00003375 NCT00003375]
 
## '''Update:''' 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. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206/ PubMed]
 
## '''Update:''' 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. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206/ PubMed]
 
==Radiation therapy {{#subobject:ae4089|Regimen=1}}==
 
==Radiation therapy {{#subobject:ae4089|Regimen=1}}==
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|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ Shaw et al. 2012 (RTOG 9802)]
 
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ Shaw et al. 2012 (RTOG 9802)]
 
|1998-2002
 
|1998-2002
|style="background-color:#91cf61"|Non-randomized portion of RCT
+
|style="background-color:#91cf61"|Non-randomized part of phase 3 RCT
 
|style="background-color:#d3d3d3"|
 
|style="background-color:#d3d3d3"|
 
|style="background-color:#d3d3d3"|
 
|style="background-color:#d3d3d3"|
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<div class="toccolours" style="background-color:#b3e2cd">
 
<div class="toccolours" style="background-color:#b3e2cd">
 
====Radiotherapy====
 
====Radiotherapy====
*[[External beam radiotherapy]] with 1.8 Gy fractions given in 30 fractions, for a total dose of 54 Gy
+
*[[External beam radiotherapy]] with 180 cGy fractions given in 30 fractions, for a total dose of 5400 cGy
 
'''6-week course'''
 
'''6-week course'''
 
</div>
 
</div>
 
<div class="toccolours" style="background-color:#cbd5e7">
 
<div class="toccolours" style="background-color:#cbd5e7">
 
====Subsequent treatment====
 
====Subsequent treatment====
*RTOG 9802: [[Low-grade_glioma_-_null_regimens#Observation|Observation]] versus [[#PCV|PCV]] x 6
+
*RTOG 9802: [[Low-grade_glioma_-_null_regimens#Observation|Observation]] versus adjuvant [[#PCV|PCV]] x 6
 
</div></div>
 
</div></div>
 
===References===
 
===References===
# '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article]  '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558 PubMed] NCT00003375
+
# '''RTOG 9802:''' Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. [https://doi.org/10.1200/JCO.2011.35.8598 link to original article]  '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558/ PubMed] [https://clinicaltrials.gov/study/NCT00003375 NCT00003375]
 
## '''Update:''' 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. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206/ PubMed]
 
## '''Update:''' 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. [https://doi.org/10.1056/NEJMoa1500925 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5170873/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27050206/ PubMed]
# '''EORTC 22033-26033:''' 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. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946/ PubMed] NCT00182819
+
# '''EORTC 22033-26033:''' 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. Epub 2016 Sep 27. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946/ PubMed] [https://clinicaltrials.gov/study/NCT00182819 NCT00182819]
#'''ECOG E3F05:''' NCT00978458
+
#'''ECOG E3F05:''' [https://clinicaltrials.gov/study/NCT00978458 NCT00978458]
 
==Temozolomide monotherapy {{#subobject:31d3b0|Regimen=1}}==
 
==Temozolomide monotherapy {{#subobject:31d3b0|Regimen=1}}==
 
<div class="toccolours" style="background-color:#eeeeee">
 
<div class="toccolours" style="background-color:#eeeeee">
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</div></div>
 
</div></div>
 
===References===
 
===References===
# '''EORTC 22033-26033:''' 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. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946/ PubMed] NCT00182819
+
# '''EORTC 22033-26033:''' 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. Epub 2016 Sep 27. [https://doi.org/10.1016/S1470-2045(16)30313-8 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27686946/ PubMed] [https://clinicaltrials.gov/study/NCT00182819 NCT00182819]
 
=Recurrent or progressive, non-curative therapy=
 
=Recurrent or progressive, non-curative therapy=
 
==Carboplatin monotherapy {{#subobject:e18c52|Regimen=1}}==
 
==Carboplatin monotherapy {{#subobject:e18c52|Regimen=1}}==
 
<div class="toccolours" style="background-color:#eeeeee">
 
<div class="toccolours" style="background-color:#eeeeee">
 
===Regimen {{#subobject:24c607|Variant=1}}===
 
===Regimen {{#subobject:24c607|Variant=1}}===
{| class="wikitable" style="width: 40%; text-align:center;"  
+
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
!style="width: 25%"|Study
+
!style="width: 33%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
+
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
|[http://thejns.org/doi/pdf/10.3171/foc.1998.4.4.6 Moghrabi et al. 1998]
+
|[https://doi.org/10.3171/foc.1998.4.4.6 Moghrabi et al. 1998]
 +
|NR
 
|style="background-color:#91cf61"|Phase 2
 
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
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</div></div>
 
</div></div>
 
===References===
 
===References===
# Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, Bruggers C, Provenzale JM, Champagne M, Hershon L, Watral M, Ryan J, Rasheed K, Lovell S, Korones D, Fuchs H, George T, McLendon RE, Friedman AH, Buckley E, Longee DC. Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus. 1998 Apr 15;4(4):e3. [http://thejns.org/doi/pdf/10.3171/foc.1998.4.4.6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17168503/ PubMed]
+
# Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, Bruggers C, Provenzale JM, Champagne M, Hershon L, Watral M, Ryan J, Rasheed K, Lovell S, Korones D, Fuchs H, George T, McLendon RE, Friedman AH, Buckley E, Longee DC. Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus. 1998 Apr 15;4(4):e3. [https://doi.org/10.3171/foc.1998.4.4.6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17168503/ PubMed]
 +
 
 
==Carboplatin & Teniposide {{#subobject:b10263|Regimen=1}}==
 
==Carboplatin & Teniposide {{#subobject:b10263|Regimen=1}}==
 
<div class="toccolours" style="background-color:#eeeeee">
 
<div class="toccolours" style="background-color:#eeeeee">
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<div class="toccolours" style="background-color:#cbd5e8">
 
<div class="toccolours" style="background-color:#cbd5e8">
 
====Preceding treatment====
 
====Preceding treatment====
*Conventional [[#Temozolomide_monotherapy|temozolomide]], with progression
+
*Conventional adjuvant [[#Temozolomide_monotherapy|temozolomide]], with progression
 
</div>
 
</div>
 
<div class="toccolours" style="background-color:#b3e2cd">
 
<div class="toccolours" style="background-color:#b3e2cd">
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</div></div><br>
 
</div></div><br>
 
<div class="toccolours" style="background-color:#eeeeee">
 
<div class="toccolours" style="background-color:#eeeeee">
 +
 
===Regimen variant #4, traditional dosing {{#subobject:4fe632|Variant=1}}===
 
===Regimen variant #4, traditional dosing {{#subobject:4fe632|Variant=1}}===
 
{| class="wikitable" style="width: 40%; text-align:center;"  
 
{| class="wikitable" style="width: 40%; text-align:center;"  
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===References===
 
===References===
 
# Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, Braguer D, Martin PM, Grisoli F. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001 May 1;19(9):2449-55. [https://doi.org/10.1200/jco.2001.19.9.2449 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11331324/ PubMed]
 
# Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, Braguer D, Martin PM, Grisoli F. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001 May 1;19(9):2449-55. [https://doi.org/10.1200/jco.2001.19.9.2449 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11331324/ PubMed]
# '''Retrospective:''' Pouratian N, Gasco J, Sherman JH, Shaffrey ME, Schiff D. Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol. 2007 May;82(3):281-8. Epub 2006 Nov 3. [https://doi.org/10.1007/s11060-006-9280-4 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17082887 PubMed]
+
# '''Retrospective:''' Pouratian N, Gasco J, Sherman JH, Shaffrey ME, Schiff D. Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol. 2007 May;82(3):281-8. Epub 2006 Nov 3. [https://doi.org/10.1007/s11060-006-9280-4 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17082887/ PubMed]
# '''RESCUE:''' Perry JR, Rizek P, Cashman R, Morrison M, Morrison T. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the "rescue" approach. Cancer. 2008 Oct 15;113(8):2152-7. [https://doi.org/10.1002/cncr.23813 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/18756530/ PubMed] NCT00392171
+
# '''RESCUE:''' Perry JR, Rizek P, Cashman R, Morrison M, Morrison T. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the "rescue" approach. Cancer. 2008 Oct 15;113(8):2152-7. [https://doi.org/10.1002/cncr.23813 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/18756530/ PubMed] [https://clinicaltrials.gov/study/NCT00392171 NCT00392171]
 
## '''Update:''' Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol. 2010 Apr 20;28(12):2051-7. Epub 2010 Mar 22. [https://doi.org/10.1200/jco.2009.26.5520 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/20308655/ PubMed]
 
## '''Update:''' Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol. 2010 Apr 20;28(12):2051-7. Epub 2010 Mar 22. [https://doi.org/10.1200/jco.2009.26.5520 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/20308655/ PubMed]
 
# Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res. 2009 Jan 1;15(1):330-7. [https://doi.org/10.1158/1078-0432.CCR-08-0888 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19118062/ PubMed]
 
# Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res. 2009 Jan 1;15(1):330-7. [https://doi.org/10.1158/1078-0432.CCR-08-0888 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19118062/ PubMed]

Revision as of 11:33, 13 May 2024

Section editor
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Seema Nagpal, MD
Stanford University
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Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit this page. If you still can't find it, please let us know so we can add it!
Note: pediatric regimens have been moved to a dedicated page:

7 regimens on this page
10 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

EANO

NCCN

Adjuvant therapy

PCV

PCV: Procarbazine, CCNU (Lomustine), Vincristine

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Shaw et al. 2012 (RTOG 9802) 1998-2002 Phase 3 (E-esc) Observation Superior OS1 (primary endpoint)
Median OS: 13.3 vs 7.8 y
(HR 0.59)

1Reported efficacy is based on the 2016 update.

Preceding treatment

  • Definitive RT x 5400 cGy

Chemotherapy

8-week cycle for 6 cycles

References

  1. RTOG 9802: Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00003375
    1. Update: 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. link to original article link to PMC article PubMed

Radiation therapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Shaw et al. 2012 (RTOG 9802) 1998-2002 Non-randomized part of phase 3 RCT
Baumert et al. 2016 (EORTC 22033-26033) 2005-2010 Phase 3 (C) Temozolomide Did not meet primary endpoint of PFS

Note: Details here are from RTOG 9802.

Radiotherapy

6-week course

Subsequent treatment

References

  1. RTOG 9802: Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP. Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol. 2012 Sep 1;30(25):3065-70. Epub 2012 Jul 30. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00003375
    1. Update: 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. link to original article link to PMC article PubMed
  2. EORTC 22033-26033: 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. Epub 2016 Sep 27. link to original article contains dosing details in abstract link to PMC article PubMed NCT00182819
  3. ECOG E3F05: NCT00978458

Temozolomide monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Baumert et al. 2016 (EORTC 22033-26033) 2005-2010 Phase 3 (E-switch-ooc) Radiotherapy Did not meet primary endpoint of PFS

Chemotherapy

28-day cycle for up to 12 cycles

References

  1. EORTC 22033-26033: 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. Epub 2016 Sep 27. link to original article contains dosing details in abstract link to PMC article PubMed NCT00182819

Recurrent or progressive, non-curative therapy

Carboplatin monotherapy

Regimen

Study Dates of enrollment Evidence
Moghrabi et al. 1998 NR Phase 2

Chemotherapy

Supportive therapy

  • Hydration for 1 hour before chemotherapy, and for 1 hour after chemotherapy; total volume including carboplatin is 900 mL/m2

28-day cycle for up to 12 cycles beyond the maximum response

References

  1. Moghrabi A, Friedman HS, Ashley DM, Bottom KS, Kerby T, Stewart E, Bruggers C, Provenzale JM, Champagne M, Hershon L, Watral M, Ryan J, Rasheed K, Lovell S, Korones D, Fuchs H, George T, McLendon RE, Friedman AH, Buckley E, Longee DC. Phase II study of carboplatin (CBDCA) in progressive low-grade gliomas. Neurosurg Focus. 1998 Apr 15;4(4):e3. link to original article contains dosing details in manuscript PubMed

Carboplatin & Teniposide

Regimen

Study Evidence
Brandes et al. 2003 Phase 2

Chemotherapy

Supportive therapy

  • Prophylactic 5-HT3 antagonists routinely used
  • Lowest dose of corticosteroids necessary to maintain neurologic stability
  • Antiepileptic medications for all patients

28-day cycle for up to 10 cycles

References

  1. Brandes AA, Basso U, Vastola F, Tosoni A, Pasetto LM, Jirillo A, Lonardi S, Paris MK, Koussis H, Monfardini S, Ermani M. Carboplatin and teniposide as third-line chemotherapy in patients with recurrent oligodendroglioma or oligoastrocytoma: a phase II study. Ann Oncol. 2003 Dec;14(12):1727-31. link to original article contains dosing details in manuscript PubMed

PCV

PCV: Procarbazine, CCNU (Lomustine), Vincristine

Regimen

Study Evidence
Brandes et al. 2004 Phase 2

Chemotherapy

Supportive therapy

42-day cycle for up to 6 cycles

References

  1. Brandes AA, Tosoni A, Vastola F, Pasetto LM, Coria B, Danieli D, Iuzzolino P, Gardiman M, Talacchi A, Ermani M. Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy: a phase II study. Cancer. 2004 Nov 1;101(9):2079-85. link to original article contains dosing details in manuscript PubMed
  2. Retrospective: Triebels VH, Taphoorn MJ, Brandes AA, Menten J, Frenay M, Tosoni A, Kros JM, Stege EB, Enting RH, Allgeier A, van Heuvel I, van den Bent MJ. Salvage PCV chemotherapy for temozolomide-resistant oligodendrogliomas. Neurology. 2004 Sep 14;63(5):904-6. link to original article PubMed

Temozolomide monotherapy

Regimen variant #1, low dose

Study Evidence
Pouratian et al. 2006 Retrospective

Chemotherapy

Supportive therapy

28-day cycle for 12 to 15 cycles


Regimen variant #2, low dose, longer cycles

Study Evidence
Kesari et al. 2009 Phase 2

Chemotherapy

Supportive therapy

77-day cycle for up to 6 cycles


Regimen variant #3, continuous therapy

Study Evidence
Perry et al. 2008 (RESCUE) Phase 2

Preceding treatment

Chemotherapy

Continued indefinitely


Regimen variant #4, traditional dosing

Study Evidence
Chinot et al. 2001 Phase 2

Chemotherapy

28-day cycle for up to 26 cycles (2 years)

References

  1. Chinot OL, Honore S, Dufour H, Barrie M, Figarella-Branger D, Muracciole X, Braguer D, Martin PM, Grisoli F. Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol. 2001 May 1;19(9):2449-55. link to original article contains dosing details in manuscript PubMed
  2. Retrospective: Pouratian N, Gasco J, Sherman JH, Shaffrey ME, Schiff D. Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol. 2007 May;82(3):281-8. Epub 2006 Nov 3. link to original article contains dosing details in manuscript PubMed
  3. RESCUE: Perry JR, Rizek P, Cashman R, Morrison M, Morrison T. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the "rescue" approach. Cancer. 2008 Oct 15;113(8):2152-7. link to original article contains dosing details in manuscript PubMed NCT00392171
    1. Update: Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol. 2010 Apr 20;28(12):2051-7. Epub 2010 Mar 22. link to original article contains dosing details in manuscript PubMed
  4. Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res. 2009 Jan 1;15(1):330-7. link to original article contains dosing details in manuscript PubMed