Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses
Research output: Contribution to journal › Research article › Contributed › peer-review
Contributors
Abstract
Purpose: In the randomized CeTeG/NOA-09 trial, lomustine/temozolomide (CCNU/TMZ) was superior to TMZ therapy regarding overall survival (OS) in MGMT promotor-methylated glioblastoma. Progression-free survival (PFS) and pseudoprogression rates (about 10%) were similar in both arms. Further evaluating this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at first progression according to modified RANO criteria (mRANO). Methods: We classified the patients of the CeTeG/NOA-09 trial according to long vs. short PPS employing a cut-off of 18 months and compared baseline characteristics and survival times. In patients with available MRIs and confirmed progression, the increase in T1-enhancing, FLAIR hyperintense lesion volume and the change in ADC mean value of contrast-enhancing tumor upon progression were determined. Results: Patients with long PPS in the CCNU/TMZ arm had a particularly short PFS (5.6 months). PFS in this subgroup was shorter than in the long PPS subgroup of the TMZ arm (11.1 months, p = 0.01). At mRANO-defined progression, patients of the CCNU/TMZ long PPS subgroup had a significantly higher increase of mean ADC values (p = 0.015) and a tendency to a stronger volumetric increase in T1-enhancement (p = 0.22) as compared to long PPS patients of the TMZ arm. Conclusion: The combination of survival and MRI analyses identified a subgroup of CCNU/TMZ-treated patients with features that sets them apart from other patients in the trial: short first PFS despite long PPS and significant increase in mean ADC values upon mRANO-defined progression. The observed pattern is compatible with the features commonly observed in pseudoprogression suggesting mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of CeTeG/NOA-09.
Details
Original language | English |
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Pages (from-to) | 607-616 |
Number of pages | 10 |
Journal | Journal of neuro-oncology |
Volume | 164 |
Issue number | 3 |
Publication status | Published - Sept 2023 |
Peer-reviewed | Yes |
External IDs
PubMed | 37728779 |
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Keywords
Sustainable Development Goals
ASJC Scopus subject areas
Keywords
- Glioblastoma, MGMT promotor methylation, MRI, Progression, Pseudoprogression, Brain Neoplasms/diagnostic imaging, Antineoplastic Agents, Alkylating/therapeutic use, Humans, Lomustine/therapeutic use, Temozolomide/therapeutic use, Dacarbazine/therapeutic use, Glioblastoma/diagnostic imaging, Magnetic Resonance Imaging