Alper Kahvecioglu, Radiation Oncologist at Hacettepe University, shared a post on X:
“Can the mature EORTC 22033-26033 trial be interpreted as evidence that upfront temozolomide can replace radiotherapy in diffuse low-grade glioma? We don’t think so.
Here’s why.
After molecular reclassification, age ≥40 years was no longer prognostic.
If age alone no longer identifies biologically high-risk disease, should patients treated solely because they were ≥40 years old still be included in the primary analysis?
A sensitivity analysis excluding these patients could provide a clearer picture of treatment effects in today’s molecular era.
Another important limitation is the absence of seizure outcomes.
For many patients with diffuse LGG, seizure control is a major reason to initiate treatment and a key determinant of quality of life.
Early RT improved long-term seizure control in EORTC 22845, but comparable long-term data for TMZ monotherapy remain limited.
It would also be valuable to report CDKN2A/B homozygous deletion.
Under the WHO 2021 classification, this molecular alteration upgrades an IDH-mutant astrocytoma to WHO grade 4 and could further refine subgroup analyses.
Finally, these mature data should be interpreted in the context of contemporary practice, where postop RT followed by adjuvant chemo remains the standard approach for eligible patients with high-risk IDH-mutant diffuse low grade gliomas.”
Title: Temozolomide Versus Radiotherapy as First-Line Therapy for Low-Grade Glioma: Mature Results of a Randomized Phase III Trial (EORTC 22033-26033/NCIC-CTG/TROG/MRC-CTU)
Authors: Brigitta Baumert, Monika Hegi, Martin van den Bent, Andreas von Deimling, Thierry Gorlia, Khê Hoang-Xuan, Alba Brandes, Paul Sargos, Martin Taphoorn, Elodie Vauleon, Claire Philips, Johan Kros, Pierre Bady, Wolfgang Wick, Roelien Enting, Michele Reni, Brian Thiessen, Frédéric Dhermain, Jacoline Bromberg, Julian Jacob, Jaap Reijneveld, Olivier Chinot, Johanna Gijtenbeek, John Rossiter, Carmen Balana, Ana Luisa Silva Azevedo, Paul Clement, Anna Berghoff, Tzahala Tzuk-Shina, Michael Weller, Robert Nordal, Jeremy Rees, Denis Lacombe, Warren Mason, Roger Stupp
Read the Full Article on Journal of Clinical Oncology
