Expert Point of View: David Reardon, MD


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We see a significant separation of the curves favoring the administration of adjuvant temozolomide, and at the landmarks of 2 and 5 years, and the difference in outcomes appears to be growing.
— David Reardon, MD

“Adjuvant temozolomide does represent a new standard of care for 1p/19q-intact anaplastic glioma patients,” according to David Reardon, MD, Clinical Director at the Dana-Farber Center for Neuro-Oncology and the study’s formal discussant at the 2016 ASCO Annual Meeting.

“We see a significant separation of the curves favoring the administration of adjuvant temozolomide,” he continued, “and at the landmarks of 2 and 5 years, the difference in outcomes appears to be growing, suggesting that with mature follow-up, we may see further separation of the curves favoring adjuvant ­temozolomide.”

Dr. Reardon also said the finding was “not too unexpected,” since it is known that “chemotherapy is active in anaplastic glioma, comparably to radiotherapy.” He added: “A recurrent theme in modern neuro-oncology is that the addition of chemotherapy to radiotherapy seems to improve outcomes, especially across the spectrum of glial tumors.” In fact, a recently published study shows that the addition of procarbazine ­(Matulane), lomustine (CeeNU), and vincristine to radiotherapy also prolonged survival in poor-risk grade II glioma,1 Dr. Reardon pointed out.

The Next Question

According to Dr. Reardon, the next question will be the role of temozolomide given concurrently with radiotherapy, which will be defined as the study matures, many years from now. The impact of MGMT (O-6-methylguanine-DNA methyltransferase) promoter methylation status and IDH mutation status on this new treatment regimen will also be important to determine. ■

Disclosure: Dr. Reardon has received honoraria from AbbVie, Bristol-Myers Squibb, Cavion, Celldex, Genentech/Roche, Inovio Pharmaceuticals, Juno Therapeutics, Merck, Midatech Pharma, Momenta Pharmaceuticals, Monteris Medical, Novartis, Novocure, OXiGENE, Regeneron, Stemline Therapeutics; has consulted for all of the above except AbbVie; and has received institutional research funding from Celldex, Incyte, and Midatech.

Reference

1. Buckner JC, Shaw EG, Pugh SL, et al: Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 374:1344-1355, 2016.


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