Should concomitant and adjuvant treatment with temozolomide be used as standard therapy in patients with anaplastic glioma?

• Published in: Critical reviews in oncology/hematology Vol. 60; no. 2; pp. 99 - 111
• Main Authors: Siker, Malika L., Chakravarti, Arnab, Mehta, Minesh P.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.11.2006; Elsevier Science
• Subjects: Anaplastic glioma; Antineoplastic Agents, Alkylating - therapeutic use; Astrocytoma; Astrocytoma - drug therapy; Astrocytoma - genetics; Astrocytoma - radiotherapy; Biological and medical sciences; Brain Neoplasms - drug therapy; Brain Neoplasms - genetics; Brain Neoplasms - radiotherapy; Carcinoma - drug therapy; Carcinoma - genetics; Carcinoma - radiotherapy; Chemoradiotherapy; Chemotherapy; Chemotherapy, Adjuvant - methods; Clinical Trials as Topic; Combined Modality Therapy; Dacarbazine - analogs & derivatives; Dacarbazine - therapeutic use; DNA Modification Methylases; DNA Repair Enzymes; Hematologic and hematopoietic diseases; Humans; Medical sciences; Neurology; Oligoastrocytoma; Oligodendroglioma; Oligodendroglioma - drug therapy; Oligodendroglioma - genetics; Oligodendroglioma - radiotherapy; Radiotherapy; Salvage Therapy; Temozolomide; Tumor Suppressor Protein p14ARF - genetics; Tumor Suppressor Proteins; Tumors of the nervous system. Phacomatoses; Chemotherapy; Anaplastic glioma; Oligoastrocytoma; Temozolomide; Radiotherapy; Chemoradiotherapy; Astrocytoma; Oligodendroglioma; Antineoplastic agent; Human; Nervous system diseases; Adjuvant treatment; Malignant tumor; Standards; Malignant glioma; Alkylating agent; Cancerology; Central nervous system disease
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2006.04.005

Malignant gliomas are devastating tumors associated with poor prognosis. Standard treatment has been surgery followed by radiotherapy while the role of chemotherapy has remained controversial. Concomitant and adjuvant treatment with temozolomide has recently been shown to improve survival in patients with glioblastoma. While it seems intuitive to apply this regimen to patients with anaplastic gliomas which have traditionally been considered more chemosensitive, chemotherapy has not been shown to prolong life in patients with anaplastic gliomas. Despite promising preclinical and early clinical results, there is currently not enough level 1 evidence to justify concomitant and adjuvant temozolomide as standard therapy for patients with newly diagnosed anaplastic gliomas. Further investigation is needed to better define the role of chemotherapy in patients with anaplastic gliomas. Trials evaluating chemoradiotherapy as well as targeted therapeutic agents are the subject of further research.