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Section editor
	Seema Nagpal, MD Stanford University Palo Alto, CA, USA LinkedIn

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:

Pediatric low-grade glioma

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

NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Central Nervous System Cancers.

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

Procarbazine (Matulane) 60 mg/m² PO once per day on days 8 to 21
Lomustine (CCNU) 110 mg/m² PO once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once per day on days 8 & 29

8-week cycle for 6 cycles

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. Epub 2012 Jul 30. link to original article dosing details in manuscript have been reviewed by our editors 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

External beam radiotherapy with 180 cGy fractions given in 30 fractions, for a total dose of 5400 cGy

6-week course

Subsequent treatment

RTOG 9802: Observation versus adjuvant PCV x 6

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. Epub 2012 Jul 30. link to original article dosing details in manuscript have been reviewed by our editors 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
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 dosing details in abstract have been reviewed by our editors link to PMC article PubMed NCT00182819
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

Temozolomide (Temodar) 75 mg/m² PO once per day on days 1 to 21

28-day cycle for up to 12 cycles

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. Epub 2016 Sep 27. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00182819

Recurrent or progressive, non-curative therapy

Carboplatin monotherapy

Regimen

Study	Dates of enrollment	Evidence
Moghrabi et al. 1998	Not reported	Phase 2

Chemotherapy

Carboplatin (Paraplatin) 560 mg/m² IV over 60 minutes once on day 1
- Mixed in D5 1/2 NS

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

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 dosing details in manuscript have been reviewed by our editors PubMed

Carboplatin & Teniposide

Regimen

Study	Dates of enrollment	Evidence
Brandes et al. 2003	1994-01 to 2002-12	Phase 2

Chemotherapy

Carboplatin (Paraplatin) 350 mg/m² IV once on day 1
Teniposide (Vumon) 50 mg/m² IV once per day on days 1 to 3

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

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 dosing details in manuscript have been reviewed by our editors PubMed

PCV

PCV: Procarbazine, CCNU (Lomustine), Vincristine

Regimen

Study	Dates of enrollment	Evidence
Brandes et al. 2004	1994-11 to 2000-09	Phase 2

Chemotherapy

Procarbazine (Matulane) 60 mg/m² PO once per day on days 8 to 21
Lomustine (CCNU) 110 mg/m² PO once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once per day on days 8 & 29

Supportive therapy

Routine use of prophylactic 5-HT3 antagonists
Steroids given at the lowest dose required by patient's neurologic status

42-day cycle for up to 6 cycles

References

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 dosing details in manuscript have been reviewed by our editors PubMed
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	Dates of enrollment	Evidence
Pouratian et al. 2006	2003-10 to 2006-06	Retrospective

Chemotherapy

Temozolomide (Temodar) 75 mg/m² PO once per day on days 1 to 21

Supportive therapy

PCP prophylaxis with Trimethoprim/Sulfamethoxazole (Bactrim)
Antiemetics and stool softeners used as needed

28-day cycle for 12 to 15 cycles

Regimen variant #2, low dose, longer cycles

Study	Dates of enrollment	Evidence
Kesari et al. 2009	Not reported	Phase 2

Chemotherapy

Temozolomide (Temodar) 75 mg/m² PO once per day on days 1 to 49

Supportive therapy

PCP prophylaxis with Trimethoprim/Sulfamethoxazole (Bactrim)

77-day cycle for up to 6 cycles

Regimen variant #3, continuous therapy

Study	Dates of enrollment	Evidence
Perry et al. 2008 (RESCUE)	2001-01 to 2005-07	Phase 2

Preceding treatment

Conventional adjuvant temozolomide, with progression

Chemotherapy

Temozolomide (Temodar) 50 mg/m² PO once per day

Continued indefinitely

Regimen variant #4, traditional dosing

Study	Dates of enrollment	Evidence
Chinot et al. 2001	1995-04 to 1999-07	Phase 2

Chemotherapy

Temozolomide (Temodar) 200 mg/m² PO once per day on days 1 to 5

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

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. link to original article dosing details in manuscript have been reviewed by our editors 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. link to original article dosing details in manuscript have been reviewed by our editors 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. link to original article dosing details in manuscript have been reviewed by our editors 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 dosing details in manuscript have been reviewed by our editors 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. link to original article dosing details in manuscript have been reviewed by our editors PubMed

@@ Line 1: / Line 1: @@
-{| class="wikitable" style="text-align:center; width:50%;"
+<span id="BackToTop"></span>
-!colspan="2" align="center" style="color:white; font-size:125%; background-color:#08519c"|'''Section editor'''
+<div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px">
-|-
+[[#top|Back to Top]]
-|style="background-color:#F0F0F0"|[[File:SeemaNagpal.jpg|frameless|upright=0.3|center]]
+</div>
-|<big>[[User:Seemanagpal|Seema Nagpal, MD]]<br>Stanford University<br>Palo Alto, CA</big>
+{{#lst:Editorial board transclusions|neuro}}
-|-
+''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>
-|}
+'''Note: pediatric regimens have been moved to a dedicated page:
+*'''[[Low-grade glioma, pediatric|Pediatric low-grade glioma]]
 {| class="wikitable" style="float:right; margin-right: 5px;"
 |-
@@ Line 12: / Line 14: @@
 |}
 {{TOC limit|limit=3}}
 =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==
-*[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30194-8/fulltext 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://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30345-5/fulltext 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]
+==NCCN==
-==[https://www.nccn.org/ NCCN]==
+*''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].''
-*[https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf NCCN Guidelines - Central Nervous System Cancers]
 =Adjuvant therapy=
-==Carboplatin & Vincristine {{#subobject:056d2c|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#top|back to top]]
-|}
-CV: '''<u>C</u>'''arboplatin & '''<u>V</u>'''incristine
-<br>VC: '''<u>V</u>'''incristine & '''<u>C</u>'''arboplatin
-===Regimen variant #1, 175/1.5 (capped vincristine) {{#subobject:caa541|Variant=1}}===
-{| class="wikitable sortable" style="width: 100%; text-align:center;"
-!style="width: 20%"|Study
-!style="width: 20%"|Years of enrollment
-!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
-!style="width: 20%"|Comparator
-!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
-|-
-|[https://doi.org/10.1200/JCO.1993.11.5.850 Packer et al. 1993]
-|NR
-| style="background-color:#91cf61" |Non-randomized
-| style="background-color:#d3d3d3" |
-| style="background-color:#d3d3d3" |
-|-
-|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413276/ Ater et al. 2012 (COG A9952)]
-|1997-2005
-| style="background-color:#1a9851" |Phase III (C)
-|[[Stub#TPCV|TPCV]]
-| style="background-color:#ffffbf" |Did not meet primary endpoints of EFS/OS
-|-
-|}
-''Note that the cycle begins on day 0.''
-====Preceding treatment====
-*[[Surgery#CNS_cancer_surgery|Biopsy or incomplete resection]]
-====Chemotherapy====
-*[[Carboplatin (Paraplatin)]] 175 mg/m<sup>2</sup> IV once per day on days 0, 7, 14, 21, 42, 49, 56, 63
-*[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 0, 7, 14, 21, 28, 35, 42, 49, 56, 63
-'''10-week course'''
-====Subsequent treatment====
-*CV maintenance
-===Regimen variant #2, 550/1.5 (uncapped vincristine) {{#subobject:31a2e6|Variant=1}}===
-{| class="wikitable sortable" style="width: 100%; text-align:center;"
-!style="width: 20%"|Study
-!style="width: 20%"|Years of enrollment
-!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
-!style="width: 20%"|Comparator
-!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
-|-
-|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517338/ Gnekow et al. 2017 (SIOP-LCG 2004)]
-|2004-2012
-| style="background-color:#1a9851" |Phase III (C)
-|[[Stub#VCE|VCE]]
-| style="background-color:#ffffbf" |Did not meet primary endpoint of PFS
-|-
-|}
-====Preceding treatment====
-*[[Surgery#CNS_cancer_surgery|Biopsy or incomplete resection]]
-====Chemotherapy====
-*[[Carboplatin (Paraplatin)]] 550 mg/m<sup>2</sup> IV over 60 minutes once on day 1
-*[[Vincristine (Oncovin)]] as follows:
-**Cycles 1 to 4: 1.5 mg/m<sup>2</sup> IV once per day on days 1, 8, 15
-**Cycles 5 to 7: 1.5 mg/m<sup>2</sup> IV once on day 1
-'''21-day cycle for 4 cycles, then 28-day cycle for 3 cycles'''
-====Subsequent treatment====
-*VC consolidation
-===References===
-# Packer RJ, Lange B, Ater J, Nicholson HS, Allen J, Walker R, Prados M, Jakacki R, Reaman G, Needles MN, Phillips PC, Ryan J, Boyett JM, Geyer R, Finlay J. Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol. 1993 May;11(5):850-6. [https://doi.org/10.1200/JCO.1993.11.5.850 link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/8487049 PubMed]
-# '''COG A9952:''' Ater JL, Zhou T, Holmes E, Mazewski CM, Booth TN, Freyer DR, Lazarus KH, Packer RJ, Prados M, Sposto R, Vezina G, Wisoff JH, Pollack IF. Randomized study of two chemotherapy regimens for treatment of low-grade glioma in young children: a report from the Children's Oncology Group. J Clin Oncol. 2012 Jul 20;30(21):2641-7. Epub 2012 Jun 4. [https://doi.org/10.1200/JCO.2011.36.6054 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413276/ link to PMC article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/22665535 PubMed]
-# '''SIOP-LGG 2004:''' Gnekow AK, Walker DA, Kandels D, Picton S, Perilongo G, Grill J, Stokland T, Sandstrom PE, Warmuth-Metz M, Pietsch T, Giangaspero F, Schmidt R, Faldum A, Kilmartin D, De Paoli A, De Salvo GL; of the Low Grade Glioma Consortium and the participating centers. A European randomised controlled trial of the addition of etoposide to standard vincristine and carboplatin induction as part of an 18-month treatment programme for childhood (≤16 years) low grade glioma - a final report. Eur J Cancer. 2017 Aug;81:206-225. Epub 2017 Jun 22. Erratum in: Eur J Cancer. 2017 Dec 13;:. [https://www.ejcancer.com/article/S0959-8049(17)30921-8/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517338/ link to PMC article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/28649001 PubMed]
 ==PCV {{#subobject:768bb0|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#top|back to top]]
-|}
 PCV: '''<u>P</u>'''rocarbazine, '''<u>C</u>'''CNU (Lomustine), '''<u>V</u>'''incristine
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:2fd5ca|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
 !style="width: 20%"|Study
-!style="width: 20%"|Years of enrollment
+!style="width: 20%"|Dates of enrollment
 !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 !style="width: 20%"|Comparator
@@ Line 112: / Line 36: @@
 |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ Shaw et al. 2012 (RTOG 9802)]
 |1998-2002
-|style="background-color:#1a9851"|Phase III (E-esc)
+|style="background-color:#1a9851"|Phase 3 (E-esc)
 |[[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)
 |-
 |}
 ''<sup>1</sup>Reported efficacy is based on the 2016 update.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
-*[[#Radiation_therapy|RT]] x 54 Gy
+*Definitive [[#Radiation_therapy|RT]] x 5400 cGy
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Procarbazine (Matulane)]] 60 mg/m<sup>2</sup> PO once per day on days 8 to 21
 *[[Lomustine (CCNU)]] 110 mg/m<sup>2</sup> PO once on day 1
 *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 8 & 29
 '''8-week cycle for 6 cycles'''
+</div></div>
 ===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 verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558 PubMed]
+# '''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]  '''dosing details in manuscript have been reviewed by our editors''' [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://www.nejm.org/doi/full/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}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:42de5e|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
 !style="width: 20%"|Study
-!style="width: 20%"|Years of enrollment
+!style="width: 20%"|Dates of enrollment
 !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 !style="width: 20%"|Comparator
@@ Line 146: / Line 69: @@
 |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ Shaw et al. 2012 (RTOG 9802)]
 |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"|
 |-
-|[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30313-8/fulltext Baumert et al. 2016 (EORTC 22033-26033)]
+|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ Baumert et al. 2016 (EORTC 22033-26033)]
 |2005-2010
-|style="background-color:#1a9851"|Phase III (C)
+|style="background-color:#1a9851"|Phase 3 (C)
 |[[#Temozolomide_monotherapy_5|Temozolomide]]
 |style="background-color:#ffffbf"|Did not meet primary endpoint of PFS
 |-
 |}
-''Details here are from RTOG 9802.''
+''Note: Details here are from RTOG 9802.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====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'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====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>
 ===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 verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732006/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22851558 PubMed]
+# '''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]  '''dosing details in manuscript have been reviewed by our editors''' [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://www.nejm.org/doi/full/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://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30313-8/fulltext link to original article] '''contains protocol''' [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] '''dosing details in abstract have been reviewed by our editors''' [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:''' [https://clinicaltrials.gov/study/NCT00978458 NCT00978458]
 ==Temozolomide monotherapy {{#subobject:31d3b0|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:2344c2|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
 !style="width: 20%"|Study
-!style="width: 20%"|Years of enrollment
+!style="width: 20%"|Dates of enrollment
 !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 !style="width: 20%"|Comparator
 !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 |-
-|[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30313-8/fulltext Baumert et al. 2016 (EORTC 22033-26033)]
+|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124485/ Baumert et al. 2016 (EORTC 22033-26033)]
 |2005-2010
-|style="background-color:#1a9851"|Phase III (E-switch-ooc)
+|style="background-color:#1a9851"|Phase 3 (E-switch-ooc)
 |[[#Radiation_therapy_4|Radiotherapy]]
 |style="background-color:#ffffbf"|Did not meet primary endpoint of PFS
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Temozolomide (Temodar)]] 75 mg/m<sup>2</sup> PO once per day on days 1 to 21
 '''28-day cycle for up to 12 cycles'''
+</div></div>
 ===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://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30313-8/fulltext link to original article] '''contains protocol''' [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] '''dosing details in manuscript have been reviewed by our editors''' [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=
 ==Carboplatin monotherapy {{#subobject:e18c52|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:24c607|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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]
-|style="background-color:#91cf61"|Phase II
+|Not reported
+|style="background-color:#91cf61"|Phase 2
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Carboplatin (Paraplatin)]] 560 mg/m<sup>2</sup> IV over 60 minutes once on day 1
 **Mixed in D5 1/2 NS
+====Supportive therapy====
-====Supportive medications====
 *Hydration for 1 hour before chemotherapy, and for 1 hour after chemotherapy; total volume including carboplatin is 900 mL/m<sup>2</sup>
 '''28-day cycle for up to 12 cycles beyond the maximum response'''
+</div></div>
 ===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 verified protocol''' [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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/17168503/ PubMed]
 ==Carboplatin & Teniposide {{#subobject:b10263|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:531596|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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]]
 |-
 |[https://doi.org/10.1093/annonc/mdg494 Brandes et al. 2003]
-|style="background-color:#91cf61"|Phase II
+|1994-01 to 2002-12
+|style="background-color:#91cf61"|Phase 2
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Carboplatin (Paraplatin)]] 350 mg/m<sup>2</sup> IV once on day 1
 *[[Teniposide (Vumon)]] 50 mg/m<sup>2</sup> IV once per day on days 1 to 3
+====Supportive therapy====
-====Supportive medications====
 *Prophylactic [[:Category:Serotonin 5-HT3 antagonists|5-HT3 antagonists]] routinely used
 *Lowest dose of [[:Category:Steroids|corticosteroids]] necessary to maintain neurologic stability
 *Antiepileptic medications for all patients
 '''28-day cycle for up to 10 cycles'''
+</div></div>
-===References===
-# 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. [https://doi.org/10.1093/annonc/mdg494 link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/14630676 PubMed]
-==Cisplatin & Etoposide (EP) {{#subobject:3a5f3f|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#top|back to top]]
-|}
-===Regimen {{#subobject:55de5f|Variant=1}}===
-{| class="wikitable" style="width: 50%; text-align:center;"
-!style="width: 25%"|Study
-!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
-|-
-|[https://doi.org/10.1007/s11060-010-0136-6 Massimino et al. 2010]
-|style="background-color:#91cf61"|Non-randomized
-|-
-|}
-''Note: In children less than 1 year old or less than 10 kg, "doses were adjusted to their weight"--reference does not say exactly how doses are adjusted.''
-====Chemotherapy====
-*[[Cisplatin (Platinol)]] 25 mg/m<sup>2</sup> IV over 2 hours once per day on days 1 to 3, '''given first'''
-*[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 3, '''given second'''
-====Supportive medications====
-*Hydration for 2 hours before chemotherapy, and for 2 hours after chemotherapy
-'''28-day cycle for 4 cycles, then 35-day cycle for 3 cycles, then 42-day cycle for 3 cycles'''
 ===References===
-# Massimino M, Spreafico F, Riva D, Biassoni V, Poggi G, Solero C, Gandola L, Genitori L, Modena P, Simonetti F, Potepan P, Casanova M, Meazza C, Clerici CA, Catania S, Sardi I, Giangaspero F. A lower-dose, lower-toxicity cisplatin-etoposide regimen for childhood progressive low-grade glioma. J Neurooncol. 2010 Oct;100(1):65-71. Epub 2010 Feb 12. [https://doi.org/10.1007/s11060-010-0136-6 link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/20151174 PubMed]
+# 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. [https://doi.org/10.1093/annonc/mdg494 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/14630676/ PubMed]
 ==PCV {{#subobject:7e7af0|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
-|-
-|[[#top|back to top]]
-|}
 PCV: '''<u>P</u>'''rocarbazine, '''<u>C</u>'''CNU (Lomustine), '''<u>V</u>'''incristine
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:6c3103|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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]]
 |-
-|[https://onlinelibrary.wiley.com/doi/10.1002/cncr.20611/full Brandes et al. 2004]
+|[https://doi.org/10.1002/cncr.20611 Brandes et al. 2004]
-|style="background-color:#91cf61"|Phase II
+|1994-11 to 2000-09
+|style="background-color:#91cf61"|Phase 2
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Procarbazine (Matulane)]] 60 mg/m<sup>2</sup> PO once per day on days 8 to 21
 *[[Lomustine (CCNU)]] 110 mg/m<sup>2</sup> PO once on day 1
 *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 8 & 29
+====Supportive therapy====
-====Supportive medications====
 *Routine use of prophylactic [[:Category:Serotonin 5-HT3 antagonists|5-HT3 antagonists]]
 *[[:Category:Steroids|Steroids]] given at the lowest dose required by patient's neurologic status
 '''42-day cycle for up to 6 cycles'''
+</div></div>
 ===References===
-# 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. [https://onlinelibrary.wiley.com/doi/10.1002/cncr.20611/full link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/15372474 PubMed]
+# 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. [https://doi.org/10.1002/cncr.20611 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/15372474/ PubMed]
-# '''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. [http://www.neurology.org/content/63/5/904.long link to original article] [https://pubmed.ncbi.nlm.nih.gov/15365146 PubMed]
+# '''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. [https://doi.org/10.1212/01.wnl.0000137049.65631.db link to original article] [https://pubmed.ncbi.nlm.nih.gov/15365146/ PubMed]
 ==Temozolomide monotherapy {{#subobject:7b66b|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen variant #1, low dose {{#subobject:863ec|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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]]
 |-
 |[https://doi.org/10.1007/s11060-006-9280-4 Pouratian et al. 2006]
+|2003-10 to 2006-06
 |style="background-color:#ffffbe"|Retrospective
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Temozolomide (Temodar)]] 75 mg/m<sup>2</sup> PO once per day on days 1 to 21
+====Supportive therapy====
-====Supportive medications====
 *PCP prophylaxis with [[Trimethoprim-Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole (Bactrim)]]
 *[[:Category:Emesis_prevention|Antiemetics]] and stool softeners used as needed
 '''28-day cycle for 12 to 15 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, low dose, longer cycles {{#subobject:50fd6b|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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://clincancerres.aacrjournals.org/content/15/1/330.long Kesari et al. 2009]
+|[https://doi.org/10.1158/1078-0432.CCR-08-0888 Kesari et al. 2009]
-|style="background-color:#91cf61"|Phase II
+|Not reported
+|style="background-color:#91cf61"|Phase 2
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Temozolomide (Temodar)]] 75 mg/m<sup>2</sup> PO once per day on days 1 to 49
+====Supportive therapy====
-====Supportive medications====
 *PCP prophylaxis with [[Trimethoprim-Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole (Bactrim)]]
 '''77-day cycle for up to 6 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, continuous therapy {{#subobject:3871fe|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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]]
 |-
-|[https://onlinelibrary.wiley.com/doi/10.1002/cncr.23813/full Perry et al. 2008 (RESCUE)]
+|[https://doi.org/10.1002/cncr.23813 Perry et al. 2008 (RESCUE)]
-|style="background-color:#91cf61"|Phase II
+|2001-01 to 2005-07
+|style="background-color:#91cf61"|Phase 2
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
-*Conventional temozolomide, with progression
+*Conventional adjuvant [[#Temozolomide_monotherapy|temozolomide]], with progression
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Temozolomide (Temodar)]] 50 mg/m<sup>2</sup> PO once per day
 '''Continued indefinitely'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #4, traditional dosing {{#subobject:4fe632|Variant=1}}===
-{| class="wikitable" style="width: 50%; 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]]
 |-
 |[https://doi.org/10.1200/jco.2001.19.9.2449 Chinot et al. 2001]
-|style="background-color:#91cf61"|Phase II
+|1995-04 to 1999-07
-|-
+|style="background-color:#91cf61"|Phase 2
-|[https://onlinelibrary.wiley.com/doi/10.1002/cncr.22961/full Nicholson et al. 2007]
-|style="background-color:#91cf61"|Non-randomized
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Temozolomide (Temodar)]] 200 mg/m<sup>2</sup> PO once per day on days 1 to 5
-**In Nicholson et al. 2007, patients who previously received craniospinal irradiation (CSI) instead received 180 mg/m<sup>2</sup> PO once per day on days 1 to 5
+'''28-day cycle for up to 26 cycles (2 years)'''
+</div></div>
-'''28-day cycle for up to 24 months (in Chinot et al. 2001) or 11 cycles (in Nicholson et al. 2007)'''
 ===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 verified protocol''' [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] '''dosing details in manuscript have been reviewed by our editors''' [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 verified protocol''' [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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/17082887/ PubMed]
-# Nicholson HS, Kretschmar CS, Krailo M, Bernstein M, Kadota R, Fort D, Friedman H, Harris MB, Tedeschi-Blok N, Mazewski C, Sato J, Reaman GH; Children's Oncology Group. Phase 2 study of temozolomide in children and adolescents with recurrent central nervous system tumors: a report from the Children's Oncology Group. Cancer. 2007 Oct 1;110(7):1542-50. [https://onlinelibrary.wiley.com/doi/10.1002/cncr.22961/full link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/17705175 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/18756530/ PubMed] [https://clinicaltrials.gov/study/NCT00392171 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://onlinelibrary.wiley.com/doi/10.1002/cncr.23813/full link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/18756530 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] '''dosing details in manuscript have been reviewed by our editors''' [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 verified protocol''' [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] '''dosing details in manuscript have been reviewed by our editors''' [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. [http://clincancerres.aacrjournals.org/content/15/1/330.long link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/19118062 PubMed]
 [[Category:Low-grade glioma regimens]]
 [[Category:Disease-specific pages]]
-[[Category:CNS cancers]]
+[[Category:Low-grade gliomas]]

Difference between revisions of "Low-grade glioma"

Latest revision as of 23:49, 20 July 2024

Guidelines

EANO

NCCN

Adjuvant therapy

PCV

Regimen

Preceding treatment

Chemotherapy

References

Radiation therapy

Regimen

Radiotherapy

Subsequent treatment

References

Temozolomide monotherapy

Regimen

Chemotherapy

References

Recurrent or progressive, non-curative therapy

Carboplatin monotherapy

Regimen

Chemotherapy

Supportive therapy

References

Carboplatin & Teniposide

Regimen

Chemotherapy

Supportive therapy

References

PCV

Regimen

Chemotherapy

Supportive therapy

References

Temozolomide monotherapy

Regimen variant #1, low dose

Chemotherapy

Supportive therapy

Regimen variant #2, low dose, longer cycles

Chemotherapy

Supportive therapy

Regimen variant #3, continuous therapy

Preceding treatment

Chemotherapy

Regimen variant #4, traditional dosing

Chemotherapy

References

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