Anaplastic glioma: current treatment and management

Abstract

Anaplastic glioma (AG) is divided into three morphology-based groups (anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma) as well as three molecular groups (glioma-CpG island methylation phenotype [G-CIMP] negative, G-CIMP positive non-1p19q codeleted tumors and G-CIMP positive codeleted tumors). The RTOG 9402 and EORTC 26951 trials established radiotherapy plus (procarbazine, lomustine, vincristine) chemotherapy as the standard of care in 1p/19q codeleted AG. Uni- or non-codeleted AG are currently best treated with radiotherapy only or alkylator-based chemotherapy only as determined by the NOA-04 trial. Maturation of NOA-04 and results of the currently accruing studies, CODEL (for codeleted AG) and CATNON (for uni or non-codeleted AG), will likely refine current up-front treatment recommendations for AG.

Dynamic Contrast‐Enhanced MRI in Low‐Grade Versus Anaplastic Oligodendrogliomas

“…The treatment and prognosis of low‐grade and anaplastic oligodendrogliomas are different. Initial treatment of anaplastic oligodendrogliomas usually involves tumor resection, adjuvant radiation, and often chemotherapy . In contrast, patients with low‐grade oligodendrogliomas typically undergo less treatment and survive longer than patients with anaplastic tumors .…”

“…Initial treatment of anaplastic oligodendrogliomas usually involves tumor resection, adjuvant radiation, and often chemotherapy. 3 In contrast, patients with low-grade oligodendrogliomas typically undergo less treatment and survive longer than patients with anaplastic tumors. 4 Accurate determination of tumor grade in patients with oligodendrogliomas is therefore clinically relevant.…”

Acute lymphoblastic leukemia following temozolomide treatment in a patient with glioblastoma: A case report and review of the literature

“…A large number of randomized clinical trials have demonstratedthe safety and efficacy of TMZ in the treatment of aggressive central nervous system tumors, revealing significantly improved overall survivalcompared with the first-generation oral alkylating agent (6)(7)(8). The United States Food and Drug Administration approved TMZ as a treatment for glioblastoma in 1999 (22).…”

“…This active drug subsequently exerts its antitumor effect by methylating the purine bases of chromosomal DNA including O6-guanine, which results in the failure of DNA replication, cell cycle arrest and subsequent apoptosis (4,5). TMZ is generally considered effective and relatively safe (6)(7)(8); however, increased survival rates in certain patients have uncovered toxicities arising from the long-term use of alkylating agents, including TMZ (9). Treatment-related secondary myelodysplastic syndrome (t-MDS) and treatment-related acute myeloid leukemia (t-AML) have been recorded in patients following prolonged (5-10 years) exposure to alkylating agents (10)(11)(12).…”

Phase I/II Study of Temozolomide Plus Nimustine Chemotherapy for Recurrent Malignant Gliomas: Kyoto Neuro-oncology Group

“…Generally, a standard treatment of a newly diagnosed malignant gliomas usually consists of cytoreductive surgery followed by radiotherapy (RT) concomitant with TMZ therapy, 1) though treatments for Grade 3 gliomas are controversial and have not being established. 2,3) The clinical benefit of adding bevacizumab to the treatment is controversial. 4–6,8) Gliadel wafers also have been often used, if possible.…”