Success at last: a molecular factor that informs treatment

Abstract

Anaplastic oligodendrogliomas are rare primary brain tumors. However, they respond more effectively to treatment and have a better prognosis than commoner varieties. About 25 year ago, reports emerged that oligodendrogliomas can respond robustly and durably to chemotherapy with procarbazine, lomustine (CCNU), and vincristine (PCV). It was also discovered that co-deletion of chromosome arms 1p and 19q is more commonly observed in oligodendrogliomas (rather than astrocytomas). Early results of phase III trials confirmed that 1p/19q co-deletion was a favorable prognostic marker. Mature results now conclusively demonstrate that co-deletion also predicts longer survival from the addition of PCV chemotherapy to radiotherapy for newly diagnosed disease. However, changes in the treatment landscape, including a preference for deferred radiotherapy, the emergence of temozolomide as a better tolerated chemotherapy regimen, and the discovery of other biomarkers (e.g. IDH mutation and MGMT promoter methylation) that occurred in the interim emphasize the need for earlier, validated, and acceptable trial end points.