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Advances in the treatment of primary brain tumors: Dawn of a new era?

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Abstract

The prognosis for patients with malignant primary brain tumors has been poor, and until recently, there was little evidence that chemotherapy was beneficial. The publication of the phase III trial comparing the combination of temozolomide with external beam radiation therapy with radiation therapy alone demonstrated a clear survival benefit for the combination regimen. These results, along with improvements in clinical trial design and outcome assessment, advances in our understanding of glioma tumor biology, and recognition of critical drug-drug interactions, have provided a foundation for developing better treatments for these cancers.

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References and Recommended Reading

  1. Walker MD, Alexander E Jr, Hunt WE, et al.: Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 1978, 49:333–343.

    Article  PubMed  CAS  Google Scholar 

  2. Walker MD, Green SB, Byar DP, et al.: Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980, 303:1323–1329. Seminal article that provided definitive data demonstrating benefit of radiation therapy for malignant gliomas.

    Article  PubMed  CAS  Google Scholar 

  3. Fine HA, Dear KB, Loeffier JS, et al.: Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 1993, 71:2585–2597.

    Article  PubMed  CAS  Google Scholar 

  4. Stewart LA: Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002, 359:1011–1018.

    Article  PubMed  CAS  Google Scholar 

  5. Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial. J Clin Oncol 2001, 19:509–518.

  6. Stupp R, Mason WP, van den Bent MJ, et al.: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005, 352:987–996. Important recent publication that provides level 1 evidence for the survival benefit of chemotherapy combined with radiation.

    Article  PubMed  CAS  Google Scholar 

  7. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG: Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 1990, 8:1277–1280. The first validated system for uniform determination of treatment response for brain tumor trials.

    PubMed  CAS  Google Scholar 

  8. Sorensen AG, Patel S, Harmath C, et al.: Comparison of diameter and perimeter methods for tumor volume calculation. J Clin Oncol 2001, 19:551–557.

    PubMed  CAS  Google Scholar 

  9. Warren KE, Patronas N, Aikin AA, et al.: Comparison of one-, two, and three-dimensional measurements of childhood brain tumors. J Natl Cancer Inst 2001, 93:1401–1405.

    Article  PubMed  CAS  Google Scholar 

  10. Chen X, Tohme M, Park R, et al.: Micro-PET imaging of alphavbeta3-integrin expression with 18F-labeled dimeric RGD peptide. Mol Imaging 2004, 3:96–104.

    Article  PubMed  CAS  Google Scholar 

  11. Jacobs A, Voges J, Reszka R, et al.: Positron-emission tomography of vector-mediated gene expression in gene therapy for gliomas. Lancet 2001, 358:727–729.

    Article  PubMed  CAS  Google Scholar 

  12. Jacobs AH, Dittmar C, Winkeler A, et al.: Molecular imaging of gliomas. Mol Imaging 2002, 1:309–335.

    Article  PubMed  CAS  Google Scholar 

  13. Jacobs AH, Voges J, Kracht LW, et al.: Imaging in gene therapy of patients with glioma. J Neurooncol 2003, 65:291–305.

    Article  PubMed  CAS  Google Scholar 

  14. Spence AM, Muzi M, Krohn KA: Molecular imaging of regional brain tumor biology. J Cell Biochem Suppl 2002, 39:25–35.

    Article  PubMed  CAS  Google Scholar 

  15. Buckner JC: Factors influencing survival in high-grade gliomas. Semin Oncol 2003, 30(Suppl 19):10–14.

    Article  PubMed  Google Scholar 

  16. Lamborn KR, Chang SM, Prados MD: Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neurooncology 2004, 6:227–235.

    Google Scholar 

  17. Wong ET, Hess KR, Gleason MJ, et al.: Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol 1999, 17:2572. An important study that provided a critical parameter for studies using 6-month progression-free survival as a measure of efficacy.

    PubMed  CAS  Google Scholar 

  18. Grant R, Liang BC, Slattery J, et al.: Chemotherapy response criteria in malignant glioma. Neurology 1997, 48:1336–1340.

    PubMed  CAS  Google Scholar 

  19. Yung WK, Albright RE, Olson J, et al.: A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 2000, 83:588–593. A large series demonstrating the efficacy of single-agent temozolomide.

    Article  PubMed  CAS  Google Scholar 

  20. Jaeckle KA, Hess KR, Yung WK, et al.: Phase II evaluation of temozolomide and 13-cis-retinoic acid for the treatment of recurrent and progressive malignant glioma: a North American Brain Tumor Consortium study. J Clin Oncol 2003, 21:2305–2311.

    Article  PubMed  CAS  Google Scholar 

  21. Groves MD, Puduvalli VK, Hess KR, et al.: Phase II trial of temozolomide plus the matrix metalloproteinase inhibitor, marimastat, in recurrent and progressive glioblastoma multiforme. J Clin Oncol 2002, 20:1383–1388.

    Article  PubMed  CAS  Google Scholar 

  22. Fetell MR, Grossman SA, Fisher JD, et al.: Preirradiation paclitaxel in glioblastoma multiforme: efficacy, pharmacology, and drug interactions. New Approaches to Brain Tumor Therapy Central Nervous System Consortium. J Clin Oncol 1997, 15:3121–3128. The first study to recognize the critical drug-drug interaction of chemotherapy with hepatic cytochrome p450 anticonvulsants.

    PubMed  CAS  Google Scholar 

  23. Grossman SA, Hochberg F, Fisher J, et al.: Increased 9-aminocamptothecin dose requirements in patients on anticonvulsants. NABTT CNS Consortium. The New Approaches to Brain Tumor Therapy. Cancer Chemother Pharmacol 1998, 42:118–126.

    Article  PubMed  CAS  Google Scholar 

  24. Gilbert MR, Supko JG, Batchelor T, et al.: Phase I clinical and pharmacokinetic study of irinotecan in adults with recurrent malignant glioma. Clin Cancer Res 2003, 9:2940–2949.

    PubMed  CAS  Google Scholar 

  25. Anderson RC, Elder JB, Brown MD, et al.: Changes in the immunologic phenotype of human malignant glioma cells after passaging in vitro. Clin Immunol 2002, 102:84–95.

    Article  PubMed  CAS  Google Scholar 

  26. Chang SM, Kuhn J, Wen P, et al.: Phase I/pharmacokinetic study of CCI-779 in patients with recurrent malignant glioma on enzyme-inducing antiepileptic drugs. Invest New Drugs 2004, 22:427–435.

    Article  PubMed  CAS  Google Scholar 

  27. Rich JN, Reardon DA, Peery T, et al.: Phase II trial of gefitinib in recurrent glioblastoma. J Clin Oncol 2004, 22:133–142.

    Article  PubMed  CAS  Google Scholar 

  28. Ino Y, Betensky RA, Zlatescu MC, et al.: Molecular subtypes of anaplastic oligodendroglioma: implications for patient management at diagnosis. Clin Cancer Res 2001, 7:839–845. One of the early papers recognizing the impact of 1p and 19q loss of heterozygosity on response and survival for anaplastic oligodendrogliomas.

    PubMed  CAS  Google Scholar 

  29. Bauman GS, Ino Y, Ueki K, et al.: Allelic loss of chromosome 1p and radiotherapy plus chemotherapy in patients with oligodendrogliomas. Int J Radiat Oncol Biol Phys 2000, 48:825–830.

    Article  PubMed  CAS  Google Scholar 

  30. Cairncross G, W, Seiferheld E, Shaw, et al.: An intergroup randomized controlled clinical trial of chemotherapy plus radiation versus RT alone for pure and mixed anaplastic oligodendrogliomas: initial report of RTOG 94–02 [abstract]. Proc ASCO 2004, 23:107.

    Google Scholar 

  31. Hill C, Hunter SB, Brat DJ: Genetic markers in glioblastoma: prognostic significance and future therapeutic implications. Adv Anat Pathol 2003, 10:212–217.

    Article  PubMed  CAS  Google Scholar 

  32. Mischel PS, Shai R, Shi T, et al.: Identification of molecular subtypes of glioblastoma by gene expression profiling. Oncogene 2003, 22:2361–2373.

    Article  PubMed  CAS  Google Scholar 

  33. Barker FG II, Simmons ML, Chang SM, et al.: EGFR overexpression and radiation response in glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001, 51:410–418.

    Article  PubMed  CAS  Google Scholar 

  34. Zhu A, Shaeffer J, Leslie S, et al.: Epidermal growth factor receptor: an independent predictor of survival in astrocytic tumors given definitive irradiation. Int J Radiat Oncol Biol Phys 1996, 34:809–815.

    Article  PubMed  CAS  Google Scholar 

  35. Huncharek M, Kupelnick B: Epidermal growth factor receptor gene amplification as a prognostic marker in glioblastoma multiforme: results of a meta-analysis. Oncol Res 2000, 12:107–112.

    PubMed  CAS  Google Scholar 

  36. Shinojima N, Tada K, Shiraishi S, et al.: Prognostic value of epidermal growth factor receptor in patients with glioblastoma multiforme. Cancer Res 2003, 63:6962–6970.

    PubMed  CAS  Google Scholar 

  37. Waha A, Baumann A, Wolf HK, et al.: Lack of prognostic relevance of alterations in the epidermal growth factor receptor-transforming growth factor-alpha pathway in human astrocytic gliomas. J Neurosurg 1996, 85:634–641.

    Article  PubMed  CAS  Google Scholar 

  38. Jaeckle KA, Eyre HJ, Townsend JJ, et al.: Correlation of tumor O6 methylguanine-DNA methyltransferase levels with survival of malignant astrocytoma patients treated with bis-chloroethylnitrosourea: a Southwest Oncology Group study. J Clin Oncol 1998, 16:3310–3315.

    PubMed  CAS  Google Scholar 

  39. Esteller M, Garcia-Foncillas J, Andion E, et al.: Inactivation of the DNA-repair gene MGMT and the clinical response of gliomas to alkylating agents. N Engl J Med 2000, 343:1350–1354.

    Article  PubMed  CAS  Google Scholar 

  40. Hegi ME, Diserens AC, Godard S, et al.: Clinical trial substantiates the predictive value of O-6-methylguanine-DNA methyltransferase promoter methylation in glioblastoma patients treated with temozolomide. Clin Cancer Res 2004, 10:1871–1874.

    Article  PubMed  CAS  Google Scholar 

  41. Hegi ME, Diserens AC, Gorlia T, et al.: MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005, 352:997–1003. This study examined a subset of samples from the EORTC/NCIC phase III trial and demonstrated the prognostic and possible response correlation with methylation of the MGMT gene promoter region.

    Article  PubMed  CAS  Google Scholar 

  42. Yung WK, Jaekle K, Kyritisis A, et al.: A combination of temozolomide and interferon-alpha in recurrent malignant gliomas, a phase II study. Neuro-oncol 1999, 1:347.

    Google Scholar 

  43. Groves MD, Tremont-Lukats TW, Conrad CA, et al.: A phase II trial of temozolomide plus thalidomide (NABTC 99–04) for recurrent glioblastoma multiforme. Neurooncology 2002, 4(Suppl 1):41.

    Google Scholar 

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Correspondence to Mark R. Gilbert MD.

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Gilbert, M.R. Advances in the treatment of primary brain tumors: Dawn of a new era?. Curr Oncol Rep 8, 45–49 (2006). https://doi.org/10.1007/s11912-006-0008-6

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