Clinical trial suggests combination therapy is best for low-grade brain tumors

(Press-News.org) COLUMBUS, Ohio - New clinical-trial findings provide further evidence that combining chemotherapy with radiation therapy is the best treatment for people with a low-grade form of brain cancer. The findings come from a phase II study co-led by a researcher at Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James) and researchers at the University of Maryland and at London Regional Cancer Program in Ontario, Canada. The study shows that patients with low-grade gliomas and at high risk for tumor recurrence have an overall survival of 73 percent after three years when treated with radiation plus temozolomide, a chemotherapy drug. This is compared with a three-year survival of 54 percent for historical controls treated with radiation alone. The findings are published in the International Journal of Radiation Oncology, Biology, Physics. "The most effective treatment for these rare tumors is currently controversial at best," says Arnab Chakravarti, MD, chair and professor of Radiation Oncology and co-director of the Brain Tumor Program at the OSUCCC - James. Chakravarti is the trial's translational research national study chair. "Many of these high-risk low-grade gliomas progress to grade III and IV tumors over time, so identifying the best treatment strategy is critical to ensure that patients have the best outcomes," says Chakravarti, who is also the Max Morehouse Chair in Cancer Research at Ohio State. "Our study reports that combining radiation with temozolomide-based chemotherapy appears to improve clinical outcome compared to historical controls treated by radiation alone. This may prove critical in killing enough tumor cells to prevent progression to stage IV disease, or glioblastoma multiforme, over time." Low-grade gliomas represent less than one percent of all human tumors in the United States. The average survival times vary depending on the tumor's structural, molecular and genetic features. (One form of high-risk low-grade glioma has an average overall survival of about 5 years.) The study's key technical findings include: The three-year progression-free survival rate was 59 percent. Grade 3 adverse events occurred in 43 percent of patients; grade 4 events occurred in 10 percent of patients. Chakravarti and his lab are currently conducting molecular studies to more specifically identify which low-grade glioma patients benefit from temozolomide.

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Funding from the National Institutes of Health/National Cancer Institute (CA021661, CA037422, CA180868) supported this research. Other researchers involved in this study were Barbara J. Fisher, MD, and David R. Macdonald, MD, London Regional Cancer Program, Ontario, Canada; Chen Hu, PhD, Radiation Therapy Oncology Group-Statistical Center, Philadelphia; Glenn J. Lesser, MD, Wake Forest University; Stephen W. Coons, MD, Barrow Neurological Institute, Phoenix; David G. Brachman, MD, Arizona Oncology Services Foundation, Phoenix; Samuel Ryu, MD, Henry Ford Hospital, Detroit; Maria Werner-Wasik, MD, Thomas Jefferson University, Philadelphia; Jean-Paul Bahary, MD, Centre Hospitalier de l'Universite´ de Montre´al-Notre Dame, Montreal, Quebec, Canada; Junfeng Liu, PhD, GCE Solutions, Inc., Bloomington, Illinois; Minesh Mehta, MD, University of Maryland. The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute strives to create a cancer-free world by integrating scientific research with excellence in education and patient-centered care, a strategy that leads to better methods of prevention, detection and treatment. Ohio State is one of only 41 National Cancer Institute (NCI)-designated Comprehensive Cancer Centers and one of only four centers funded by the NCI to conduct both phase I and phase II clinical trials. The NCI recently rated Ohio State's cancer program as "exceptional," the highest rating given by NCI survey teams. As the cancer program's 306-bed adult patient-care component, The James is a "Top Hospital" as named by the Leapfrog Group and one of the top cancer hospitals in the nation as ranked by U.S. News & World Report.