CODEL: Phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p/19q codeleted oligodendroglioma. Analysis from the initial study design

Kurt A. Jaeckle*, Karla V. Ballman, Martin Van Den Bent, Caterina Giannini, Evanthia Galanis, Paul D. Brown, Robert B. Jenkins, J. Gregory Cairncross, Wolfgang Wick, Michael Weller, Kenneth D. Aldape, Jesse G. Dixon, S. Keith Anderson, Jane H. Cerhan, Jeffrey S. Wefel, Martin Klein, Stuart A. Grossman, David Schiff, Jeffrey J. Raizer, Frederick DhermainDonald G. Nordstrom, Patrick J. Flynn, Michael A. Vogelbaum

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

50 Citations (Scopus)

Abstract

Background: We report the analysis involving patients treated on the initial CODEL design. Methods: Adults (>18) with newly diagnosed 1p/19q World Health Organization (WHO) grade III oligodendroglioma were randomized to radiotherapy (RT; 5940 centigray) alone (arm A); RT with concomitant and adjuvant temozolomide (TMZ) (arm B); or TMZ alone (arm C). Primary endpoint was overall survival (OS), arm A versus B. Secondary comparisons were performed for OS and progression-free survival (PFS), comparing pooled RT arms versus TMZ-alone arm. Results: Thirty-six patients were randomized equally. At median follow-up of 7.5 years, 83.3% (10/12) TMZ-alone patients progressed, versus 37.5% (9/24) on the RT arms. PFS was significantly shorter in TMZ-alone patients compared with RT patients (hazard ratio [HR] = 3.12; 95% CI: 1.26, 7.69; P = 0.014). Death from disease progression occurred in 3/12 (25%) of TMZ-alone patients and 4/24 (16.7%) on the RT arms. OS did not statistically differ between arms (comparison underpowered). After adjustment for isocitrate dehydrogenase (IDH) status (mutated/wildtype) in a Cox regression model utilizing IDH and RT treatment status as covariables (arm C vs pooled arms A + B), PFS remained shorter for patients not receiving RT (HR = 3.33; 95% CI: 1.31, 8.45; P = 0.011), but not OS ((HR = 2.78; 95% CI: 0.58, 13.22, P = 0.20). Grade 3+ adverse events occurred in 25%, 42%, and 33% of patients (arms A, B, and C). There were no differences between arms in neurocognitive decline comparing baseline to 3 months. Conclusions: TMZ-alone patients experienced significantly shorter PFS than patients treated on the RT arms. The ongoing CODEL trial has been redesigned to compare RT + PCV versus RT + TMZ.

Original languageEnglish
Pages (from-to)457-467
Number of pages11
JournalNeuro-Oncology
Volume23
Issue number3
DOIs
Publication statusPublished - 1 Mar 2021

Bibliographical note

Funding Information:
The research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology), UG1CA233320, UG1CA233329, UG1CA232760; U10CA180820; U10CA180863 (CCTG); and U10CA180868 (NRG). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright: © 2020 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved.

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