Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma

Hannah Webb, Mercer University College of Pharmacy

Grade 2 gliomas occur most commonly in young adults and cause progressive neurologic deterioration and premature death. Treatment with procarbazine, CCNU, and vincristine have been found to increase progression-free survival, but not overall survival, than radiation therapy alone. [1]

Title: Radiation plus Procarbazine (PCV), loumstine (CCNU), and Vincristine in Low-Grade Glioma
Design Long-term follow-up of a phase 3 trial; N= 251
Objective To report the long-term results of treatment with PCV, CCNU, and vincristine after radiation therapy at the time of initial diagnosis
Study Groups Radiation therapy alone (n= 126); PCV and radiation therapy (n= 125)
Methods Patients were eligible for this trial if they had supratentorial grade 2 astrocytoma, oligodendroglioma, or oligoastrocytoma that was histologically confirmed on pathological review by a central laboratory before randomization. The radiation dose was 54 Gy, administered in 30 fractions of 1.8 Gy each over a period of 6 weeks. The radiation volume was defined according to the abnormality on the T2-weighted magnetic resonance imagining (MRI) signal, including any surgical defect.
Duration 1998 to 2002
Primary Outcome Measure Assessment of the most common toxic effects of radiation therapy alone vs. radiation therapy plus PCV
Baseline Characteristics Radiation Therapy Alone Radiation Therapy plus PCV
Median age, years 40 41
Sex
Male 61% 52%
Female 39% 48%
Race
White 92% 89%
Hispanic 4% 6%
Black 4% 5%
Karnofsky performance-status score
60-80 26% 25%
90 or 100 74% 75%
Histologic findings
Astrocytoma 23% 29%
Oligodendroglioma 45% 40%
Oligoastrocytoma 32% 31%
Results Radiation therapy alone Radiation therapy plus PCV
Fatigue 54.0% 64%
Weight loss 7.1% 22.4%
Hemoglobin decreased 1.6% 39.2%
Packed red-cell transfusion 0% 2.4%
Platelet count decreased 1.6% 44%
Platelet transfusion 0% 0.8%
Febrile neutropenia 0% 0.8%
Infection 0.8% 22.2%
Adverse Events Common Adverse Events: fatigue (61.7%), weight loss (24.5%)
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions This phase 3 trial showed a survival benefit among patients with a grade 2 glioma who were treated with radiation therapy plus chemotherapy, as compared with those who received radiation therapy alone.

In this long term trial of overall survival, it was shown that progression free survival and overall survival were longer among those who received combination chemotherapy in addition to radiation therapy than among those who received radiation therapy alone. The magnitude of treatment benefit from combined chemotherapy plus radiation therapy is substantial, but the toxic effects are greater than those observed with radiation therapy alone. Patients and their physicians will have to weigh whether the longer survival justifies the more toxic therapeutic approach.

References

Buckner, Jan, Edward Shaw, Stephanie Pugh, Arnab Chakravarti, mark Gilbert, Geoffrey Barger, Stephen Coons, and Peter Ricci. Radiation plus Procarbazine, CCNU, and Voncristine in Low-Grade Glioma. The New England Journal of Medicine. 2016; 374: 1344-55.

 

 

 

 

 

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