Temozolomide and Radiotherapy versus Radiotherapy Alone in Patients with Glioblastoma, IDH-wildtype: Post Hoc Analysis of the EORTC Randomized Phase III CATNON Trial.
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Tesileanu C Mircea S, Sanson Marc, Wick Wolfgang, Brandes Alba A, Clement Paul M, Erridge Sara C, Vogelbaum Michael A, Nowak Anna K, Baurain Jean-Francois, Mason Warren P, Wheeler Helen, Chinot Olivier L, Gill Sanjeev, Griffin Matthew, Rogers Leland, Taal Walter, Rudà Roberta, Weller Michael, McBain Catherine, van Linde Myra E, Aldape Kenneth, Jenkins Robert B, Kros Johan M, Wesseling Pieter, von Deimling Andreas, Hoogstrate Youri, de Heer Iris, Atmodimedjo Peggy N, Dubbink Hendrikus J, Brouwer Rutger W W, van IJcken Wilfred F J, Cheung Kin Jip, Golfinopoulos Vassilis, Baumert Brigitta G, Gorlia Thierry, French Pim J, van den Bent Martin J
Аннотация
PATIENTS AND METHODS: From the randomized phase III CATNON study examining the addition of adjuvant and concurrent temozolomide to radiotherapy in anaplastic astrocytomas, we selected a subgroup of IDH1/2wt and H3F3Awt tumors with presence of TERT promoter mutations and/or EGFR amplifications and/or combined gain of chromosome 7 and loss of chromosome 10. Molecular abnormalities including MGMT promoter methylation status were determined by next-generation sequencing, DNA methylation profiling, and SNaPshot analysis.
RESULTS: Of the 751 patients entered in the CATNON study, 670 had fully molecularly characterized tumors. A total of 159 of these tumors met the WHO 2021 molecular criteria for glioblastoma, IDH-wt. Of these patients, 47 received radiotherapy only and 112 received a combination of radiotherapy and temozolomide. There was no added effect of temozolomide on either overall survival [HR, 1.19; 95% confidence interval (CI), 0.82-1.71] or progression-free survival (HR, 0.87; 95% CI, 0.61-1.24). MGMT promoter methylation was prognostic for overall survival, but was not predictive for outcome to temozolomide treatment either with respect to overall survival or progression-free survival.
CONCLUSIONS: In this cohort of patients with glioblastoma, IDH-wt temozolomide treatment did not add benefit beyond that observed from radiotherapy, regardless of MGMT promoter status. These findings require a new well-powered prospective clinical study to explore the efficacy of temozolomide treatment in this patient population.