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Weller J, Zeyen T, Schlegel U, Lazaridis L, Werner JM, Onken J, Zeiner P, Drexler R, Hau P, Seidel C, Grosse L, Clusmann H, Sabel M, Ringel F, Pichler J, Grauer O, Hundsberger T, Schnell O, Mair MJ, Uhl M, Schmidt-Graf F, Glas M, Galldiks N, Unteroberdörster M, Steinbach J, Ricklefs F, Renovanz M, Delev DI, Turgut MO, Flesch OR, Cipriani D, Preusser M, Kebir S, Misch M, Goldbrunner R, Westphal M, Tabatabai G, Schäfer N, Schneider M, Vatter H, Giordano F, Schaub C, Herrlinger U. CTNI-07. LOMUSTINE/TEMOZOLOMIDE CHEMOTHERAPY FOR NEWLY DIAGNOSED MGMT-METHYLATED IDHWT GLIOBLASTOMA ACCORDING TO CETEG/NOA-09: REAL-WORLD EXPERIENCE IN A MULTICENTER COHORT. Neuro Oncol 2022. [PMCID: PMC9660822 DOI: 10.1093/neuonc/noac209.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
The CeTeG/NOA-09 trial demonstrated superior median overall survival (mOS, 48.1 months) in MGMT-methylated glioblastoma treated with lomustine/temozolomide compared to temozolomide. We retrospectively analyzed an off-study cohort of patients treated with lomustine/temozolomide to gather real-world data on this new regimen.
METHODS
Adult patients from 20 centers in Germany, Austria and Switzerland were included. Inclusion criteria were MGMT-methylated IDHwt glioblastoma newly diagnosed prior to end of 2020, and lomustine/temozolomide treatment as part of first-line therapy.
RESULTS
321 patients with a median age of 57 years (range, 21-78) and a median follow-up of 19.9 months were included. In the whole cohort, mOS was 41.0 months (95%CI, 33.0 – not reached). In patients starting lomustine/temozolomide immediately upon initiation of radiotherapy strictly following the CeTeG protocol (88%), mOS was 52.8 months (35.8 – not reached) as compared to 24.6 months (17.6 – not reached) in patients starting lomustine/temozolomide after completion of radiotherapy/concomitant temozolomide (12%, logrank test: p = 0.06). Patients with a KPS < 80 had a shorter mOS of 19.7 months (95%CI, 16.6 – not reached) compared to 41.0 months (33.0 – not reached, p = 0.009) in KPS 80-100. Gross total resection (GTR, 53.9%) was associated with longer mOS (52.8 months, 95%CI 24.1 – not reached) compared to partial resection/biopsy (30.5 months, 95%CI 36.8 – not reached, p=0.004). Multivariable Cox regression analysis confirmed GTR (HR 0.66, p = 0.033) and younger age ( ≤ 50 years: HR 0.42, p = 0.001), but not KPS (80-100 vs. lower: HR 0.66, p = 0.12) as independent prognostic factors.
DISCUSSION
In this real-world multicenter cohort, survival was similar to the promising results of CeTeG/NOA-09. Further analyses should investigate a potentially reduced benefit from lomustine/temozolomide in patients with low KPS/no GTR and a possible detrimental effect from deferred lomustine/temozolomide initiation. The median follow-up is admittedly short, updated data will be presented.
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Affiliation(s)
- Johannes Weller
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Thomas Zeyen
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr–University Bochum , Bochum , Germany
| | - Lazaros Lazaridis
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany , Essen , Germany
| | - Jan-Michael Werner
- Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | - Julia Onken
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Pia Zeiner
- Dr. Senckenberg Institute of Neurooncology , Frankfurt , Germany
| | - Richard Drexler
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Peter Hau
- Universitätsklinikum Regensburg , Regensburg , Germany
| | - Clemens Seidel
- Department of Radiotherapy, University Hospital Leipzig , Leipzig , Germany
| | - Lucia Grosse
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Hans Clusmann
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University , Aachen , Germany
| | - Michael Sabel
- Department of Neurosurgery, University of Düsseldorf , Düsseldorf , Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz , Mainz , Germany
| | - Josef Pichler
- Department of Internal Medicine, Neuromed Campus Wagner-Jauregg, Kepler University Hospital, Johannes Kepler University of Linz , Linz , Austria
| | - Oliver Grauer
- Department of Neurology, University Hospital Münster , Münster , Germany
| | - Thomas Hundsberger
- Departments of Neurology and Hematology/Oncology, Kantonsspital St.Gallen , St. Gallen , Switzerland
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg , Freiburg , Germany
| | - Maximilian J Mair
- Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - Martin Uhl
- Department of Neurology, University Hospital Erlangen , Erlangen , USA
| | | | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany , Essen , Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich (FZJ) , Juelich , Germany
| | | | | | - Franz Ricklefs
- Universitry Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Daniel Ivanov Delev
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University , Aachen , Germany
| | - Merih O Turgut
- Department of Neurosurgery, University Medical Center Mainz , Mainz , Germany
| | - Oliver R Flesch
- Department of Neurosurgery, University of Düsseldorf , Düsseldorf , Germany
| | - Debora Cipriani
- Department of Neurosurgery, University of Freiburg , Freiburg , Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - Sied Kebir
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany , Essen , Germany
| | - Martin Misch
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Roland Goldbrunner
- Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | | | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Niklas Schäfer
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn , Bonn , Germany
| | - Frank Giordano
- Department of Radiation Oncology, University Hospital Bonn , Bonn , Germany
| | - Christina Schaub
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Ulrich Herrlinger
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
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