CATNON: concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q codeletion
Twelve cycles of temozolomide after radiotherapy lengthened survival in grade 3 glioma without 1p/19q codeletion, while giving temozolomide during radiotherapy added nothing in these tumours.
Overview
Phase 3 factorial trial of 745 adults with newly diagnosed anaplastic glioma without 1p/19q codeletion randomised to radiotherapy alone, with concurrent temozolomide, with 12 cycles of adjuvant temozolomide, or with both.
Adjuvant temozolomide improved overall survival (hazard ratio 0.65; five-year survival 55.9 versus 44.1 percent); concurrent temozolomide did not, and later analysis showed benefit was confined to IDH-mutant tumours.
- Adjuvant temozolomide: five-year overall survival 55.9 percent vs 44.1 percent; hazard ratio 0.65.
- Concurrent temozolomide: no significant benefit.
Radiotherapy followed by a year of temozolomide is the standard for grade 3 IDH-mutant astrocytoma; concurrent temozolomide is not needed, and IDH-wild-type tumours behave and are treated like glioblastoma.
- Interim analysis; final results confirmed the pattern.
- Applies to the pre-2021 category of anaplastic astrocytoma, now IDH-mutant astrocytoma grade 3.
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