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Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma.

Al's Comment:

 This article says that using more than 6 months of Temozolomide is not better than using 6 months of it as far as survival goes. That is counter-intuitive.  I would like to see larger studies to confirm it.

Posted on: 03/17/2017

Neurology. 2017 Mar 15. pii: 10.1212/WNL.0000000000003809. doi: 10.1212/WNL.0000000000003809. [Epub ahead of print]

Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma.

Gramatzki D1, Kickingereder P2, Hentschel B2, Felsberg J2, Herrlinger U2, Schackert G2, Tonn JC2, Westphal M2, Sabel M2, Schlegel U2, Wick W2, Pietsch T2, Reifenberger G2, Loeffler M2, Bendszus M2, Weller M2.
Author information
To explore an association with survival of modifying the current standard of care for patients with newly diagnosed glioblastoma of surgery followed by radiotherapy plus concurrent and 6 cycles of maintenance temozolomide chemotherapy (TMZ/RT → TMZ) by extending TMZ beyond 6 cycles.
The German Glioma Network cohort was screened for patients with newly diagnosed glioblastoma who received TMZ/RT → TMZ and completed ≥6 cycles of maintenance chemotherapy without progression. Associations of clinical patient characteristics, molecular markers, and residual tumor determined by magnetic resonance imaging after 6 cycles of TMZ with progression-free survival (PFS) and overall survival (OS) were analyzed with the log-rank test. Multivariate analyses using the Cox proportional hazards model were performed to assess associations of prolonged TMZ use with outcome.
Sixty-one of 142 identified patients received at least 7 maintenance TMZ cycles (median 11, range 7-20). Patients with extended maintenance TMZ treatment had better PFS (20.5 months, 95% confidence interval [CI] 17.7-23.3, vs 17.2 months, 95% CI 10.2-24.2, p = 0.035) but not OS (32.6 months, 95% CI 28.9-36.4, vs 33.2 months, 95% CI 25.3-41.0, p = 0.126). However, there was no significant association of prolonged TMZ chemotherapy with PFS (hazard ratio [HR] = 0.8, 95% CI 0.4-1.6, p = 0.559) or OS (HR = 1.6, 95% CI 0.8-3.3, p = 0.218) adjusted for age, extent of resection, Karnofsky performance score, presence of residual tumor, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, or isocitrate dehydrogenase (IDH) mutation status.
These data may not support the practice of prolonging maintenance TMZ chemotherapy beyond 6 cycles.
This study provides Class III evidence that in patients with newly diagnosed glioblastoma, prolonged TMZ chemotherapy does not significantly increase PFS or OS.
© 2017 American Academy of Neurology.


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