Professional Documents
Culture Documents
Correspondence to C.M.
Key advances christine.marosi@meduniwien.ac.at
• CNS4+, the updated WHO classification of nervous system tumours, integrates doi:10.1038/nrneurol.2017.3
histomorphological and molecular genetic parameters for the diagnosis of primary brain tumours1 Published online 20 Jan 2017
• Adjuvant chemotherapy with procarbazine, vincristine and lomustine following radiotherapy led
1. Louis, D. N. et al. The 2016 World Health
to a survival gain in high-risk patients with diffuse gliomas3 Organization Classification of Tumors of the Central
• The results of the EORTC trial 22033 confirm the predictive value of molecular genetic Nervous System: a summary. Acta Neuropathol. 131,
803–820 (2016).
subgroups in low-grade glioma4 2. van den Bent, M. J. Chemotherapy for low-grade
• Adjuvant chemotherapy with temozolomide prolongs survival in patients with anaplastic glioma: when, for whom, which regimen? Curr. Opin.
Neurol. 28, 633–938 (2015).
gliomas without 1p/19q codeletion6 3. Buckner, J. C. et al. Radiation plus procarbazine,
• Chemoradiation with temozolomide is beneficial for otherwise fit elderly patients with newly CCNU, and vincristine in low-grade glioma. N. Engl.
J. Med. 374, 1344–1355 (2016).
diagnosed glioblastoma8 4. Baumert, B. G. et al. Temozolomide chemotherapy
versus radiotherapy in high-risk low-grade glioma
(EORTC 22033–26033): a randomised, open-label,
After a median follow‑up of 27 months, considered as a feasible treatment option in fit phase 3 intergroup study. Lancet Oncol. 17,
the interim analysis showed a hazard ratio elderly patients with glioblastoma. 1521–1532 (2016).
5. Reijneveld, J. C. et al. Health-related quality of life in
reduction of 0.645 (95% CI 0.450–0.926, In the field of neuro-oncology, the main patients with high-risk low-grade glioma (EORTC
P = 0.0014) for overall survival when adjuvant advances over the past year lie in a refined 22033–26033): a randomised, open-label, phase 3
intergroup study. Lancet Oncol. 17, 1533–1542
temozolomide was used. Whether concomi- classification of primary brain tumours using (2016).
tant chemotherapy is also beneficial in these increasingly sophisticated techniques, and in 6. van den Bent, M. J. et al. Results of the interim
analysis of the EORTC randomized phase III CATNON
patients will be known in 2021. the extension of our knowledge on indica- trial on concurrent and adjuvant temozolomide in
For elderly patients with glioblastoma, tions for and sequencing of classic radiation anaplastic glioma without 1p/19q co‑deletion: an
intergroup trial [abstract]. J. Clin. Oncol. 34 (Suppl.),
therapeutic concepts have evolved consid- and alkylating chemotherapy approaches. LBA2000 (2016).
erably in recent years, and radiotherapy Unfortunately, like previous years, 2016 7. Wirsching, H. G., Happold, C., Roth, P. & Weller, M.
Management of diffusely infiltrating glioma
and chemotherapy monotherapy regimens failed to deliver positive trial results for bio- in the elderly. Curr. Opin. Oncol. 27, 502–509
adapted to patient age and O6-methylguanine- logical agents in gliomas. The ACT‑IV trial (2015).
8. Perry, J. R. et al. A phase III randomized controlled
DNA-methyltransferase (MGMT) promoter evaluating rindopepimut, a vaccine target- trial of short-course radiotherapy with or without
methylation status have been defined7. In ing epidermal growth factor receptor var- concomitant and adjuvant temozolomide in elderly
patients with glioblastoma (CCTG CE.6, EORTC
2016, Perry et al. reported the results of a iant III (EGFRvIII), was stopped early for 26062–22061, TROG 08.02, NCT00482677)
Canadian-led phase III trial, in which short- futility, thereby dashing the hopes raised [abstract]. J. Clin. Oncol. 34 (Suppl.), LBA2 (2016).
9. Phillips, A. C. et al. ABT‑414, an antibody-drug
course radiation therapy (40 Gy in 15 frac- by earlier smaller trials. Hopefully, ongoing conjugate targeting a tumor-selective EGFR epitope.
tions over 3 weeks) combined with concurrent trials with other novel agents, such as immune Mol. Cancer Ther. 15, 661–669 (2016).
10. Preusser, M., Lim, M., Hafler, D. A., Reardon, D. A.
and adjuvant temozolomide was compared checkpoint inhibitors targeting programmed & Sampson, J. H. Prospects of immune checkpoint
with radiotherapy alone in fit newly diag- death 1 (PD‑1), or the drug–antibody conju- modulators in the treatment of glioblastoma. Nat.
Rev. Neurol. 11, 504–514 (2015).
nosed glioblastoma patients aged ≥65 years8. gate ABT‑414, which targets amplified EGFR,
The addition of temozolomide to radiother- will produce more-encouraging results in Competing interests statement
apy extended the median overall survival 2017 and beyond9,10. M.P. has received research support from Boehringer
Ingelheim, GlaxoSmithKline, Merck Sharp & Dohme and
from 7.6 months to 9.3 months, and quality Roche, and honoraria for lectures, consultation or advisory
Matthias Preusser and Christine Marosi are at the
of life was not diminished with the com- Department of Medicine I, Clinical Division of Oncology,
board participation from Bristol-Myers Squibb, Novartis,
Gerson Lehrman Group, CMC Contrast, GlaxoSmithKline,
bined therapy. These findings indicate that Comprehensive Cancer Center CNS Unit (CCC-CNS), Mundipharma, Roche and Astra Zeneca. C.M. declares no
multimodal therapy is beneficial and can be Waehringer Guertel 18–20, 1090 Vienna, Austria. competing interests.