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  • Multicenter phase II study ...
    Thomas, Alissa A; Abrey, Lauren E; Terziev, Robert; Raizer, Jeffrey; Martinez, Nina L; Forsyth, Peter; Paleologos, Nina; Matasar, Matthew; Sauter, Craig S; Moskowitz, Craig; Nimer, Stephen D; DeAngelis, Lisa M; Kaley, Thomas; Grimm, Sean; Louis, David N; Cairncross, J Gregory; Panageas, Katherine S; Briggs, Samuel; Faivre, Geraldine; Mohile, Nimish A; Mehta, Jayesh; Jonsson, Philip; Chakravarty, Debyani; Gao, Jianjiong; Schultz, Nikolaus; Brennan, Cameron W; Huse, Jason T; Omuro, Antonio

    Neuro-oncology (Charlottesville, Va.), 10/2017, Letnik: 19, Številka: 10
    Journal Article

    Anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA) are chemotherapy-sensitive tumors with prolonged survival after radiochemotherapy. We report a prospective trial using induction temozolomide (TMZ) followed by myeloablative high-dose chemotherapy (HDC) with autologous stem-cell transplant (ASCT) as a potential strategy to defer radiotherapy. Patients with AO/AOA received 6 cycles of TMZ (200 mg/m2 × 5/28 day). Responding patients were eligible for HDC (thiotepa 250 mg/m2/day × 3 days, then busulfan 3.2 mg/kg/day × 3 days), followed by ASCT. Genomic characterization was performed using next-generation sequencing. Forty-one patients were enrolled; 85% had 1p/19q codeleted tumors. After induction, 26 patients were eligible for HDC-ASCT and 21 agreed to proceed. There were no unexpected adverse events or toxic deaths. After median follow-up of 66 months, 2-year progression-free survival (PFS) for transplanted patients was 86%, 5-year PFS 60%, and no patient has died. Among all 1p/19q codeleted patients (N = 33), 5-year PFS was 50% and 5-year overall survival (OS) 93%, with median time to radiotherapy not reached. Next-generation sequencing disclosed typical oligodendroglioma-related mutations, including IDH1, TERT, CIC, and FUBP1 mutations in 1p/19q codeleted patients, and glioblastoma-like signatures in 1p/19q intact patients. Aside from IDH1, potentially oncogenic/actionable mutations were variable, depicting wide molecular heterogeneity within oligodendroglial tumors. TMZ followed by HDC-ASCT can be safely administered to patients with newly diagnosed 1p/19q codeleted AO. This strategy was associated with promising PFS and OS, suggesting that a chemotherapy-based approach may delay the need for radiotherapy and radiation-related toxicities. Raw data for further genomic and meta-analyses are publicly available at http://cbioportal.org/study?id=odg_msk_2017, accessed 6 January 2017. NCT00588523.