Patterns, predictors and prognostic relevance of high-grade hematotoxicity after temozolomide or temozolomide-lomustine in the CeTeG/NOA-09 trial

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • J. Weller - , University of Bonn (Author)
  • N. Schäfer - , University of Bonn (Author)
  • C. Schaub - , University of Bonn (Author)
  • T. Tzaridis - , University of Bonn (Author)
  • T. Zeyen - , University of Bonn (Author)
  • M. Schneider - , University of Bonn (Author)
  • A. L. Potthoff - , University of Bonn (Author)
  • F. A. Giordano - , Heidelberg University  (Author)
  • J. P. Steinbach - , University Hospital Frankfurt (Author)
  • P. S. Zeiner - , University Hospital Frankfurt (Author)
  • T. Kowalski - , Ruhr University Bochum (Author)
  • M. Sabel - , Heinrich Heine University Düsseldorf (Author)
  • P. Hau - , University of Regensburg (Author)
  • D. Krex - , Department of Neurosurgery (Author)
  • O. Grauer - , University of Münster (Author)
  • R. Goldbrunner - , University of Cologne (Author)
  • O. Schnell - , University of Freiburg (Author)
  • G. Tabatabai - , University of Tübingen (Author)
  • F. Ringel - , Johannes Gutenberg University Mainz (Author)
  • F. Schmidt-Graf - , Technical University of Munich (Author)
  • S. Brehmer - , University of Mannheim (Author)
  • J. C. Tonn - , Ludwig Maximilian University of Munich (Author)
  • L. Bullinger - , Charité – Universitätsmedizin Berlin (Author)
  • P. Vajkoczy - , Charité – Universitätsmedizin Berlin (Author)
  • M. Glas - , University of Duisburg-Essen (Author)
  • H. Vatter - , University of Bonn (Author)
  • U. Herrlinger - , University of Bonn (Author)
  • C. Seidel - , Leipzig University (Author)

Abstract

Purpose: In the randomized phase III trial CeTeG/NOA-09, temozolomide (TMZ)/lomustine (CCNU) combination therapy was superior to TMZ in newly diagnosed MGMT methylated glioblastoma, albeit reporting more frequent hematotoxicity. Here, we analyze high grade hematotoxicity and its prognostic relevance in the trial population. Methods: Descriptive and comparative analysis of hematotoxicity adverse events ≥ grade 3 (HAE) according to the Common Terminology of Clinical Adverse Events, version 4.0 was performed. The association of HAE with survival was assessed in a landmark analysis. Logistic regression analysis was performed to predict HAE during the concomitant phase of chemotherapy. Results: HAE occurred in 36.4% and 28.6% of patients under CCNU/TMZ and TMZ treatment, respectively. The median onset of the first HAE was during concomitant chemotherapy (i.e. first CCNU/TMZ course or daily TMZ therapy), and 42.9% of patients with HAE receiving further courses experienced repeat HAE. Median HAE duration was similar between treatment arms (CCNU/TMZ 11.5; TMZ 13 days). Chemotherapy was more often discontinued due to HAE in CCNU/TMZ than in TMZ (19.7 vs. 6.3%, p = 0.036). The occurrence of HAE was not associated with survival differences (p = 0.76). Regression analysis confirmed older age (OR 1.08) and female sex (OR 2.47), but not treatment arm, as predictors of HAE. Conclusion: Older age and female sex are associated with higher incidence of HAE. Although occurrence of HAE was not associated with shorter survival, reliable prediction of patients at risk might be beneficial to allow optimal management of therapy and allocation of supportive measures. Trial registration: NCT01149109.

Details

Original languageEnglish
Pages (from-to)147-153
Number of pages7
JournalJournal of neuro-oncology
Volume161
Issue number1
Publication statusPublished - Jan 2023
Peer-reviewedYes

External IDs

PubMed 36609807

Keywords

Sustainable Development Goals

Keywords

  • Glioblastoma, Hematotoxicity, Lomustine, MGMT, Temozolomide, Glioblastoma/therapy, Prognosis, Humans, Lomustine/therapeutic use, Brain Neoplasms/therapy, Temozolomide/therapeutic use, Dacarbazine/adverse effects, Female, Antineoplastic Agents, Alkylating/adverse effects