Glioblastoma Survival Rate Quadrupled with Temozolomide Plus Radiation

By Martha Kerr

LOS ANGELES OCT 31, 2007 (Reuters Health) - For the first time in approximately 30 years, a new treatment approach has improved the long-term survival rate of patients with glioblastoma.

Long-term results of a randomized trial of temozolomide plus radiation compared with radiation alone after surgery "improves survival by a factor of four," reported Dr. Rene Olivier Mirimanoff of the University of Lausanne, Switzerland.

Dr. Mirimanoff presented the findings of an international team of investigators during a press conference at the 49th annual meeting of the American Society of Therapeutic Radiology and Oncology.

The study involved 573 patients between the ages of 18 and 70 with newly diagnosed glioblastoma, WHO grade IV, who were randomized to standard radiation therapy, with 60 Gy given in 30-day fractions of 2 Gy, or to combination therapy, consisting of standard radiation plus temozolomide, 75 mg/m² daily for 35-42 days, followed by up to four cycles of temozolomide, 150 mg/m² five days a week for 28 days.

After a mean follow-up of 45.9 months, median survival was 12.1 months in the radiation-only arm and 14.6 months in the temozolomide-plus-radiation arm of the study.

The 2-year survival was 11.2% with radiation alone and 27.3% with combination therapy. The 3-year survival rate was 4.3% with radiation and 16.7% with combination therapy, and at 4 years the corresponding rates were 3.8% vs. 12.9%.

Radiation plus temozolomide is most effective in patients with RPA class 3, indicating a relatively good prognosis, and those with suppression of the repair gene, methylated MGMT, Dr. Mirimanoff said.

"There is some hope for a substantial minority of patients with glioblastoma. Patients are living longer with good quality of life," the investigator noted.

"There is some cognitive impact with surgery for glioblastoma, but temozolomide does not further compromise quality of life," Dr. Mirimanoff told Reuters Health.

"This is the most progress in the treatment of glioblastoma in the past 30 years in terms of survival," he asserted.

"This is the good news story of the meeting," panel chairman Dr. Anthony Zeitman of Massachusetts General Hospital in Boston, Massachusetts, commented. "We may actually be turning a corner in treatment of this disease."


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