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• W2045641192 abstract "Glioblastomas are the most common primary brain tumours in adults. Despite surgical resection and focal radiotherapy, the prognosis is poor, with a median survival of 12 months. Adjuvant chemotherapy with nitrosourea does not have a substantial effect in randomised studies; only a large meta-analysis found a moderate increase in survival. The positive results of a phase III trial of a combination of radiotherapy and temozolomide is therefore a major advance in the care of these patients. 1 Stupp R Mason WP Van Den Bent MJ et al. Concomitant and adjuvant temozolomide (TMZ) and radiotherapy (RT) for newly diagnosed glioblastoma multiforme (GBM): conclusive results of a randomised phase III trial by the EORTC Brain & RT Groups and NCIC Clinical Trials Group. J Clin Oncol. 2004; 22: 2 Google Scholar In this trial by the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada, 573 patients were randomised to standard radiotherapy or radiotherapy combined with concomitant daily temozolomide followed by a maximum of six cycles of adjuvant temozolomide. Grade 3–4 haematotoxicity was found in 7% of patients during concomitant temozolomide and radiotherapy. Median survival and 2 year survival were higher in the temozolomide and radiotherapy arm than in the radiotherapy only arm (15 months vs 12 months, and 26% vs 8%, p<0·0001). Most patients (65%) in the radiotherapy arm received temozolomide at later recurrence, suggesting that a temporal association of temozolomide and radiotherapy is needed for optimum results. Whether temozolomide is best given during or after radiotherapy is unclear and this deserves further study. Another challenge will be to identify the patients who are the most likely to benefit from chemotherapy. One mechanism of resistance to nitrosourea or temozolomide is the DNA repair protein 06 methylguanine DNA methyl transferase (MGMT). Results on the predictive value for chemosensitivity of the promoter hypermethylation of the MGMT gene (silencing the gene) within the tumour are not clear. A large analysis of the MGMT status is being done on patients who participated in the trial of radiotherapy and temozolomide; preliminary data suggest that patients with tumours that do not express MGMT are most likely to benefit from the combination regimen." @default.
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• W2045641192 title "Neuro-oncology: the growing role of chemotherapy in glioma" @default.
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• W2045641192 doi "https://doi.org/10.1016/s1474-4422(04)00944-5" @default.
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