The Brain Tumour Group initiates and conducts research to challenge, re-define and develop standards of care in controversial areas of diagnostic and therapeutic neuro-oncology. The Group is especially focused on diffuse gliomas of adulthood of World Health Organisation grades II to IV and, in recent years, also meningioma.
PRACTICE CHANGING RESEARCH
Glioblastoma is an aggressive and lethal type of brain cancer that appears in people of all ages. According to the World Health Organisation, glioblastomas are classified as Grade IV and represent (along with grade III gliomas) the majority of brain tumours . Overall, glioblastomas incidence is 1 per 10 000 cases among all cancer types. However, they represent 16% of all primary brain tumours, making them the most common brain cancer and almost always the most lethal [2, 3, 4]. Today, long-term glioblastoma survivors are defined as patients who live longer than 2 years following their diagnosis whereas extreme survivors, living 10 years or more, account for 1% of all patients . This EORTC trial was instrumental to the prolonged survival of glioblastoma patients and remains the standard of care to this date.
Prior to this EORTC trial, the only available treatment involved surgery to remove the tumour followed by radiotherapy of the brain. This treatment however had very little impact on patients’ survival. The EORTC trial successfully showed that a drug called temozolomide, when taken as a pill after surgery and in addition to radiotherapy, allowed many patients to live longer. In addition, taking this pill did not cause too many adverse effects to patients, who reported on average that their quality of life was not worse than that reported by the patients not taking the drug.
Since a large number of patients saw an improvement by taking this drug, researchers tried to identify ways they could predict which patients would benefit (i.e., live longer) from this treatment and which have less chance of doing so. They succeeded in identifying a gene as the first predictive marker in brain tumours (called MGMT promoter methylation) associated with a better response to the treatment. To date, this molecular test is used in all patients with glioblastoma and was the one that introduced the concept of personalised treatment in neuro-oncology. This personalised combination treatment became the standard of care for newly diagnosed glioblastoma patients worldwide.
Study coordinator: Prof. Roger Stupp
CATNON study: Improving survival of brain tumour patients by effectively combining radiotherapy and chemotherapy (temozolomide) (EORTC 26053/22054)
Anaplastic gliomas are a rare type of brain tumours. Every year, just 1 in 100,000 people is diagnosed with this cancer. In the majority of these cases, between 70% to 80%, the patients have a specific gene change (called the IDH gene). When the trial was designed, it was clear that the chemotherapy drug
temozolomide (TMZ for short) increased survival in patients with grade 4 brain tumours (gliomas). However, for patients with grade 3 brain tumours (gliomas) that had this mutation of the IDH gene, this chemotherapy did not yield the same positive results. The trial successfully showed that when grade 3 patients are given a combination treatment in a specific order – with radiotherapy first, followed by administering the drug temozolomide – their survival rate doubles. This has been an important study in the field of brain tumours providing a significant increase in the survival of patients with anaplastic gliomas to date.
Study coordinator: Prof. Martin J. van den Bent
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