OBJECTIVES:
Primary
- Determine whether there is a survival advantage for patients with newly diagnosed 1p/19q codeleted anaplastic glioma who receive concurrent temozolomide and radiotherapy (RT) followed by adjuvant temozolomide over that observed in patients treated with RT alone (control).
Secondary
- Determine whether there is a neurocognitive advantage in patients who receive temozolomide alone (Arm III) vs temozolomide with concurrent RT (Arm II) over that observed in patients treated with RT alone (Arm I).
- Determine whether there is a difference in survival based on t(1;19)(q10,p10) translocation status and MGMT promoter hypermethylation status in these patients.
- Perform descriptive comparisons of additional secondary outcome endpoints, including time to progression, progression free survival, and the proportion of patients free of progression at 6, 12, and 24 months.
- Determine the toxicity of RT and concurrent/adjuvant temozolomide in these patients.
- Determine descriptively whether it is reasonable to delay RT by documenting the time to progression and progression-free survival of patients receiving temozolomide alone.
- Determine the quality of life and neurocognitive effects in patients treated on this protocol and correlate these results with outcome endpoints.
- Bank blood products (i.e., plasma, DNA, and buffy coat) and tumor tissue for future scientific investigations.
OUTLINE: This is a multicenter study. Patients are stratified according to cooperative group (EORTC vs North American groups [NCCTG, RTOG, CTSU, and NCIC CTG]), age (≤ 50 years vs > 50 years), and ECOG performance status (0-1 vs 2). Patients are randomized to 1 of 3 treatment arms.
- Arm I: Patients undergo radiotherapy (RT) 5 days a week for 6 weeks in the absence of disease progression or unacceptable toxicity.
- Arm II: Patients undergo RT as in arm I and receive oral temozolomide once daily on days 1-7 for 6 weeks. Beginning 4 weeks after completion of concurrent chemoradiotherapy, patients receive adjuvant oral temozolomide once daily days 1-5. Treatment with adjuvant temozolomide repeats every 28 days for 6-12 courses in the absence of disease progression and unacceptable toxicity.
- Arm III: Patients receive oral temozolomide once daily on days 1-5. Treatment repeats every 28 days for 12 courses in the absence of disease progression or unacceptable toxicity.
Patients complete neurocognitive questionnaires (i.e., the Hopkins Verbal Learning test, the Controlled Oral Word Association test from the Multilingual Aphasia Examination, General Mental Ability: Trail Making tests A and B, and the Recall and Recognition of Word List encoded from the HVLT-R test) and quality of life questionnaires (i.e., EORTC QOL-C30 and QOL-BN20) at baseline and periodically during study therapy.
Tumor tissue samples are collected during surgery and analyzed by FISH to detect t(1:19), and for MGMT gene promoter hypermethylation status and additional known prognostic markers, including but not limited to PTEN, EGFR, EGFRvIII, and p53.
After completion of study therapy, patients are followed periodically.
DISEASE CHARACTERISTICS:
- Histologically confirmed 1p/19q codeleted anaplastic glioma
- Astrocytoma (WHO grade III)
- Oligodendroglioma
- Mixed glioma
- Newly diagnosed disease
- Willing to provide tissue samples for central pathology
- Tumor tissue samples available for mandatory central pathology review submission and deletion status determination
- Must have had surgical diagnosis within the past 3 months
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- ANC ≥ 1,500/μL
- Platelet count ≥ 100,000/μL
- Hemoglobin > 9.0 g/dL
- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
- SGOT ≤ 3 times ULN
- Creatinine ≤ 1.5 times ULN
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during this study and for up to 6 months after the completion of temozolomide treatment
- Willing to provide tissue samples for translational research purposes
- Willing and able to complete neurocognitive examination without assistance and quality of life questionnaires with or without assistance
- No comorbid systemic illness or other severe concurrent disease that, in the judgment of the investigator, would preclude patient participation in this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
- No concomitant serious immunocompromised status (other than that related to concomitant steroids)
- No active uncontrolled systemic infection or HIV
- No other active malignancy except nonmelanoma skin cancer or carcinoma in situ of the cervix
- No history of myocardial infarction within the past 6 months or congestive heart failure requiring use of concurrent/ongoing maintenance therapy for life-threatening ventricular arrhythmias
- No recent history of hepatitis infection or at significant risk of reactivation of hepatitis
PRIOR CONCURRENT THERAPY:
- At least 2 weeks since prior surgery and recovered
- No prior surgery, radiotherapy or chemotherapy for any CNS neoplasm (hormones, vitamins and growth factors are not considered chemotherapy for the purposes of this study)
- Prior biopsy and/or resection showing low-grade glioma that has now a biopsy and/or resection showing anaplastic glioma and that has not had any other treatment (radiotherapy or chemotherapy) allowed
- No concurrent surgical procedures for tumor debulking, other types of chemotherapy, immunotherapy or biologic therapy, or additional stereotactic boost radiotherapy
- No other concurrent investigational agent that would be considered as a treatment for this cancer
- No other concurrent specific treatment (other than hormonal therapy) for that cancer in patients with a history of prior malignancy
Last updated: 06/17/2012
NCT ID: NCT00887146
IRB Number:08-006431
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