Up-front temozolomide in elderly patients with anaplastic oligodendroglioma and oligoastrocytoma

• Published in: Journal of neuro-oncology 2011-02, Vol.101 (3), p.457-462
• Main Authors: Ducray, François, Sierra del Rio, Monica, Carpentier, Catherine, Psimaras, Dimitri, Idbaih, Ahmed, Dehais, Caroline, Kaloshi, Gentian, Mokhtari, Karima, Taillibert, Sophie, Laigle-Donadey, Florence, Omuro, Antonio, Sanson, Marc, Delattre, Jean-Yves, Hoang-Xuan, Khê
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents, Alkylating - pharmacology; Brain Neoplasms - drug therapy; Brain Neoplasms - genetics; Brain Neoplasms - pathology; Clinical Study – Patient Study; Dacarbazine - analogs & derivatives; Dacarbazine - pharmacology; DNA Methylation; DNA Modification Methylases - genetics; DNA Repair Enzymes - genetics; DNA, Neoplasm - genetics; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Neurology; Oligodendroglioma - drug therapy; Oligodendroglioma - genetics; Oligodendroglioma - pathology; Oncology; Polymerase Chain Reaction; Promoter Regions, Genetic - genetics; Retrospective Studies; Survival Rate; Treatment Outcome; Tumor Suppressor Proteins - genetics
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-010-0264-z

Optimal treatment of anaplastic oligodendroglial tumors (AOT) in elderly patients is debatable. We report a retrospective study of 44 consecutive patients aged 70 years or older [median age: 74 years; median Karnofsky performance status (KPS): 70] treated with up-front chemotherapy using temozolomide (TMZ) at conventional doses until tumor progression. O 6 -methylguanine-DNA methyltransferase promoter (MGMTP) methylation was assessed in 38 patients. Of the 41 evaluable patients, partial response (PR) was seen in 13 (32%) patients, 17 (41%) patients achieved stable disease, while the disease progressed in 11 (27%) patients. Median progression-free survival (PFS) and overall survival (OS) were 6.9 and 12.4 months, respectively. Hematoxicity grades 3–4 occurred in nine patients (20%). MGMTP was methylated in 50% of patients and was associated with both longer PFS (8.7 versus 5.7 months, P  = 0.01) and longer OS (16.1 versus 12.4 months, P  = 0.05). The rate of responders to chemotherapy was similar in MGMTP-methylated (38%) and in MGMTP-unmethylated patients (31%), but duration of response was significantly longer in responders with methylated MGMTP than in responders with unmethylated MGMTP (16.1 versus 9.6 months, P  = 0.0004). This study demonstrates that a substantial number of elderly patients with AOT can achieve prolonged survival with up-front chemotherapy using TMZ. Further investigation is needed to determine whether this treatment is preferable to initial radiation therapy.