Artikel
Questionable long-term benefit of initial temozolomide monotherapy in IDH-mutant astrocytomas grade 2 and 3
Fragwürdiger Langzeitvorteil einer initialen Temozolomid-Monotherapie in der Behandlung IDH-mutierter Astrozytome WHO Grad 2 und 3
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Autoren
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Jonathan Weller
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Sophie Katzendobler
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Stefanie Quach
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Hannes Becker
- Universitätsklinikum Tübingen, Tübingen, Deutschland
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Frederic Thiele
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Mario Dorostkar
- Klinikum der Ludwig-Maximilians-Universität München, Neuropathologie, München, Deutschland
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Bogdana Suchorska
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland; Sana Kliniken Duisburg, Neurochirurgie, Duisburg, Deutschland
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Niklas Thon
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Jörg-Christian Tonn
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: The role of temozolomide monotherapy in IDH-mutant (IDHmut) astrocytomas after biopsy or tumor resection has not been conclusively determined.
Methods: In this retrospective, single-center study, 151 patients with IDHmut WHO grade 2 or 3 according to WHO 2016 and seen between 2001 and 2019 were investigated. Treatment groups were stratified according to initial biopsy (BX) versus tumor resection (RES) and further divided into different cohorts depending on postsurgical management: either wait-and-scan (WS), temozolomide monotherapy (TMZ) or radiotherapy alone (RT). Patient-related, clinical and molecular data were correlated with progression-free (PFS) and overall survival (OS). Initial T2 tumor volumes were measured.
Results: Patient numbers and initial T2 volumes were distributed as follows (n, number of patients; ml, median volume): BX/WS: n=43, 59ml; RES/WS: n=26, 26ml; BX/TMZ: n=27, 78ml; RES/TMZ: n= 14, 101ml; BX/RT: n=18, 27ml; RES/RT: n=23, 61ml. No significant difference in median patient age and clinical status was seen. Patients receiving radiotherapy after biopsy or resection showed a better OS than patients treated with temozolomide alone (median OS in years: 14.4 versus 10.7; p=0.01). Patients monitored through a wait-and-scan strategy showed superior OS when compared to temozolomide, irrespective of extent of resection (median OS not reached; p<0.001). Of note, this was not mirrored by PFS (p=0.9). In multivariate analyses, only initial T2 volume was associated with prolonged progression-free and overall survival.
Conclusion: Temozolomide monotherapy, if preceded by biopsy or tumor resection only, might not be beneficial in the treatment of IDHmut gliomas in the long run. Small initial T2 volume is associated with prolonged PFS and OS in IDHmut astrocytoma WHO grade 2 and 3.
Figure 1 [Fig. 1]
