作者
Salah Eddine Oussama Kacimi,Caroline Dehais,L. Feuvret,Olivier Chinot,Alain Carpentier,Charlotte Bronnimann,Élodie Vauléon,Apolline Djelad,Elizabeth Cohen‐Jonathan Moyal,Olivier Langlois,Mario Campone,Mathilde Ducloie,G. Noël,Stefania Cuzzubbo,Luc Taillandier,Carole Ramirez,Nadia Younan,Philippe Meneï,F. Dhermain,C. Desenclos,François Ghiringhelli,Veronique Bourg,Damien Ricard,Thierry Faillot,Romain Appay,Émeline Tabouret,Lucia Nichelli,Bertrand Mathon,Alice Thomas,Suzanne Tran,Franck Bielle,Agustí Alentorn,J. Bryan Iorgulescu,Pierre‐Yves Boëlle,Karim Labreche,Khê Hoang‐Xuan,Marc Sanson,Ahmed Idbaïh,Dominique Figarella‐Branger,François Ducray,Mehdi Touat,C. Desenclos,N. Guillain,Philippe Meneï,Audrey Rousseau,T Cruel,Saioa López,M. Abad,N. Hamdan,Clovis Adam,Fabrice Parker,Romuald Seizeur,Isabelle Quintin‐Roué,Guillaume Chotard,Charlotte Bronnimann,Damien Ricard,Catherine Godfraind,Toufik Khallil,Dominique Cazals‐Hatem,Thierry Faillot,C. Gaultier,M.-C. Tortel,Ioana Carpiuc,Philippe Richard,H. Aubriot-Lorton,François Ghiringhelli,Apolline Djelad,Claude‐Alain Maurage,E.M. Gueye,François Labrousse,François Ducray,David Meyronet,Dominique Figarella‐Branger,Olivier Chinot,Luc Bauchet,Valérie Rigau,G. Gauchotte,Luc Taillandier,Mario Campone,Delphine Loussouarn,Veronique Bourg,F. Vandenbos-Burel,Jean Sébastien Guillamo,Pascal Roger,Claire Bléchet,H. Adle-Biassette,Franck Bielle,Alain Carpentier,Caroline Dehais,Serge Milin,Michel Wager,Philippe Colin,M.D. Diebold,Danchristian Chiforeanu,Élodie Vauléon,Florent Marguet,Olivier Langlois,Fabien Forest,M.J. Motso-Fotso,Marie Andraud,Benoît Lhermitte,G. Noël,Michèle Bernier,Nadia Younan,Cécilia Rousselot-Denis,Ilyess Zemmoura,Christophe Joubert,Elisabeth Cohen-Moyal,Emmanuelle Uro‐Coste,F. Dhermain
摘要
PURPOSE Patients with IDH-mutant 1p/19q-codeleted grade 3 oligodendroglioma (O3 IDHmt/Codel ) benefit from adding alkylating agent chemotherapy to radiotherapy (RT). However, the optimal chemotherapy regimen between procarbazine, 1-(2-Chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), and vincristine (PCV) and temozolomide (TMZ) remains unclear given the lack of randomized trial data comparing both regimens. METHODS The objective was to assess the overall survival (OS) and progression-free survival (PFS) associated with first-line PCV/RT versus TMZ/RT in patients newly diagnosed with O3 IDHmt/Codel . We included patients with histologically proven O3 IDHmt/Codel (according to WHO criteria) from the French national prospective cohort Prise en charge des OLigodendrogliomes Anaplasiques (POLA). All tumors underwent central pathological review. OS and PFS from surgery were estimated using the Kaplan-Meier method and Cox regression model. RESULTS 305 newly diagnosed patients with O3 IDHmt/Codel treated with RT and chemotherapy between 2008 and 2022 were included, of which 67.9% of patients (n = 207) were treated with PCV/RT and 32.1% with TMZ/RT (n = 98). The median follow-up was 78.4 months (IQR, 44.3-102.7). The median OS was not reached (95% CI, Not reached [NR] to NR) in the PCV/RT group and was 140 months (95% CI, 110 to NR) in the TMZ/RT group (log-rank P = .0033). On univariable analysis, there was a significant difference in favor of PCV/RT in both 5-year (PCV/RT: 89%, 95% CI, 85 to 94; TMZ/RT: 75%, 95% CI, 66 to 84) and 10-year OS (PCV/RT: 72%, 95% CI, 61 to 85; TMZ/RT: 60%, 95% CI, 49 to 73), which was confirmed using the multivariable Cox model adjusted for age, type of surgery, gender, Eastern Cooperative Oncology Group performance status, and CDKN2A homozygous deletion (hazard ratio, 0.53 for PCV/RT, 95% CI, 0.30 to 0.92, P = .025). CONCLUSION In patients with newly diagnosed O3 IDHmt/Codel from the POLA cohort, first-line PCV/RT was associated with better OS outcomes compared with TMZ/RT. Our data suggest that the improved safety profile associated with TMZ comes at the cost of inferior efficacy in this population. Further investigation using prospective randomized studies is warranted.