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Chemotherapy Sequence With Radiation Make Little Difference In Brain Tumors: Presented at ASCO

By Ed Susman

NEW ORLEANS, LA -- June 8, 2004 -- The sequence in which patients with brain cancer receive chemotherapy -- whether at the time of radiation therapy or when the tumor progresses -- does not appear to make a significant difference in outcomes, say Canadian researchers.

However, there does appear to be a major difference in outcome if the brain cancer contains certain mutations, said Gregory Cairncross, MD, professor of clinical neurosciences and of oncology at the University of Alberta, Edmonton, Alberta, Canada.

Presenting his group's findings here, June 7th, at the American Society of Clinical Oncology 40th Annual Meeting, Dr. Cairncross explained how he and his colleagues in the Radiation Therapy Oncology Group compared survival between 148 patients with anaplastic oligodendrogliomas (AO) and anaplastic oligoastrocytomas who had radiation therapy plus the chemotherapy regimen PCV which consists of procarbazine, lomustine, and vincristine, and 143 patients who had radiation therapy alone.

Although the median survival did not differ significantly between the 2 groups -- 4.8 years for the PCV group and 4.5 years for those who had radiation alone, the time it took for the disease to progress tended to be longer in the PCV group -- 2.6 years versus 1.9 years. Severe side effects were more common in the PCV group, however.

Since most of the patients in the radiation-only group were treated with chemotherapy once their tumors progressed, the overall survival was similar, Dr. Cairncross said, "The trial indicates that the way clinicians sequence chemotherapy with radiation does not appear to be critical in overall outcome."

However, what did make a difference was that patients with specific chromosomal mutations -- specifically mutations of the short arm of Chromosome 1 and on the long arm of Chromosome 19 -- who had these brain cancers had a much more favorable outcome that did patients without the mutations, Dr. Cairncross said.

About half the patients with the chromosome aberrations survived for 7 years, Dr. Cairncross said, whereas just about 10% of the patients without the mutations survived 7 years. "The difference in survival appears to be independent of the type of treatment they received in the trial," he said.

Oligodendrogliomas with this genetic signature have a better natural history and response to treatment, said Dr. Cairncross. He suggested that oncologists may be able to use this information about the genetic differences in patients to choose the most appropriate treatment for these patients.

[Presentation title: 1500 An intergroup randomized controlled clinical trial (RCT) of chemotherapy plus radiation (RT) versus RT alone for pure and mixed anaplastic oligodendrogliomas: Initial report of RTOG 94-02.]

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