A Phase III study of radiation therapy (RT) and O⁶-benzylguanine + BCNU versus RT and BCNU alone and methylation status in newly diagnosed glioblastoma and gliosarcoma: Southwest Oncology Group (SWOG) study S0001.

Abstract

AIMS:

To determine the efficacy of methylguanine methyltransferase (MGMT) depletion + BCNU [1,3-bis(2-chloroethyl)-1- nitrosourea: carmustine] therapy and the impact of methylation status in adults with glioblastoma multiforme (GBM) and gliosarcoma.

METHODS:

Methylation analysis was performed on GBM patients with adequate tissue samples. Patients with newly diagnosed GBM or gliosarcoma were eligible for this Phase III open-label clinical trial. At registration, patients were randomized to Arm 1, which consisted of therapy with O(6)-benzylguanine (O(6)-BG) + BCNU 40 mg/m(2) (reduced dose) + radiation therapy (RT) (O6BG + BCNU arm), or Arm 2, which consisted of therapy with BCNU 200 mg/m(2) + RT (BCNU arm).

RESULTS:

A total of 183 patients with newly diagnosed GBM or gliosarcoma from 42 U.S. institutions were enrolled in this study. Of these, 90 eligible patients received O(6)-BG + BCNU + RT and 89 received BCNU + RT. The trial was halted at the first interim analysis in accordance with the guidelines for stopping the study due to futility (<40 % improvement among patients on the O6BG + BCNU arm). Following adjustment for stratification factors, there was no significant difference in overall survival (OS) or progression-free survival (PFS) between the two groups (one sided p = 0.94 and p = 0.88, respectively). Median OS was 11 [95 % confidence interval (CI) 8-13] months for patients in the O6BG + BCNU arm and 10 (95 % CI 8-12) months for those in the BCNU arm. PFS was 4 months for patients in each arm. Adverse events were reported in both arms, with significantly more grade 4 and 5 events in the experimental arm.

CONCLUSIONS:

The addition of O(6)-BG to the standard regimen of radiation and BCNU for the treatment patients with newly diagnosed GBM and gliosarcoma did not provide added benefit and in fact caused additional toxicity.

• Authors: Deborah T Blumenthal, Cathryn Rankin, Keith J Stelzer, Alexander M Spence, Andrew E Sloan, Dennis F Moore Jr, Gilbert D A Padula, Susan B Schulman, Mark L Wade, Elisabeth J Rushing
• Journal: International journal of clinical oncology (Int J Clin Oncol) Vol. 20 Issue 4 Pg. 650-8 (Aug 2015) ISSN: 1437-7772 [Electronic] Japan
• PMID: 25407559 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Antineoplastic Agents
• Guanine
• O-(6)-methylguanine
• Carmustine

Topics

• Adult
• Aged
• Antineoplastic Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Brain Neoplasms (metabolism, therapy)
• Carmustine (administration & dosage)
• Combined Modality Therapy
• DNA Methylation
• Female
• Glioblastoma (metabolism, therapy)
• Gliosarcoma (metabolism, therapy)
• Guanine (administration & dosage, analogs & derivatives)
• Humans
• Male
• Middle Aged
• Radiotherapy
• Young Adult