Front-line Systemic Therapy for Anaplastic Glioma

A chromosome contains genes. Patients who have chromosomes that have lost their 1p and 19q arms are said to have a 1p/19q deletion. This gene deletion can help to predict the patients response to chemotherapy.

It is recommended that genetic testing be carried out to determine if patients have the 1p/19q deletion.

For patients performing poorly, options to consider are radiotherapy given over a shorter period of time compared to normal, temozolomide or best supportive care, a type of medical care that focuses on relieving the symptoms caused by serious illnesses. Temozolomide is an oral chemotherapy drug that damages the DNA of cancer cells, thus killing them.

Patients who have the 1p/19q deletion and are performing well should use radiation with procarbazine, lomustine and vincristine (PCV) after surgery. PCV is a combination of 3 chemotherapy drugs used together in a chemotherapy regimen. Procarbazine damages cancer cell DNA, causing cancer cells to die.

Lomustine inhibits DNA and RNA synthesis by cancer cells, causing them to stop growing. Vincristine stops cancer cells from dividing properly, thus causing them to die.

Radiotherapy delivered over the course of many days given concurrently with temozolomide is a reasonable option after discussion with the clinician regarding current limited clinical data.

Patients who do not have the 1p/19q deletion and are performing well should use fractionated external beam radiation therapy (ERBT) after surgery. Fractionated external beam radiation therapy is a form of radiotherapy that uses beams to target and kill cancer cells and is spread out over a few doses. Temozolomide with PCV and deferred radiation is also a reasonable choice. Radiotherapy delivered over the course of many days given concurrently with temozolomide is a reasonable option but has not been shown to be beneficial in a small local study.