Temozolomide Versus Radiotherapy as First-Line Treatment for Low-Grade Glioma

Mature results of the phase 3 EORTC 22033-26033 trial (n=478) showed NO difference between temozolomide and radiotherapy as first-line therapy for high-risk low-grade glioma, in either progression-free or overall survival, regardless of molecular subtype. In IDH-mutant, 1p/19q non-codeleted astrocytoma (n=178) median overall survival was similar in both arms (6.6-6.7 years; P=.93), and in 1p/19q codeleted oligodendroglioma (n=109) it was 12.9 years with radiotherapy versus 14.9 years with temozolomide (HR 0.88; 95% CI 0.52-1.49). The only group favouring temozolomide was tumours WITHOUT IDH mutation (n=64): 4.7 versus 2.5 years (HR 0.47; 95% CI 0.27-0.82; P=.0068). The authors note that the trial did not test combined-modality therapy, which has since become standard of care in IDH-mutant astrocytoma.