Treatment-associated imaging changes in newly diagnosed MGMT promoter-methylated glioblastoma undergoing chemoradiation with or without cilengitide

Christina Maria Flies, Michel Friedrich, Philipp Lohmann, Karin Alida van Garderen, Marion Smits, Joerg-Christian Tonn, Michael Weller, Norbert Galldiks, Tom Jan Snijders*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background Radiological progression may originate from progressive disease (PD) or pseudoprogression/treatment-associated changes. We assessed radiological progression in O6-methylguanine-DNA methyltransferase (MGMT) promoter-methylated glioblastoma treated with standard-of-care chemoradiotherapy with or without the integrin inhibitor cilengitide according to the modified response assessment in neuro-oncology (RANO) criteria of 2017.Methods Patients with >= 3 follow-up MRIs were included. Preliminary PD was defined as a >= 25% increase of the sum of products of perpendicular diameters (SPD) of a new or increasing lesion compared to baseline. PD required a second >= 25% increase of the SPD. Treatment-associated changes require stable or regressing disease after preliminary PD.Results Of the 424 evaluable patients, 221 patients (52%) were randomized into the cilengitide and 203 patients (48%) into the control arm. After chemoradiation with or without cilengitide, preliminary PD occurred in 274 patients (65%) during available follow-up, and 88 of these patients (32%) had treatment-associated changes, whereas 67 patients (25%) had PD. The remaining 119 patients (43%) had no further follow-up after preliminary PD. Treatment-associated changes were more common in the cilengitide arm than in the standard-of-care arm (24% vs. 17%; relative risk, 1.3; 95% CI, 1.004-1.795; P = .047). Treatment-associated changes occurred mainly during the first 6 months after RT (54% after 3 months vs. 13% after 6 months).Conclusions With the modified RANO criteria, the rate of treatment-associated changes was low compared to previous studies in MGMT promoter-methylated glioblastoma. This rate was higher after cilengitide compared to standard-of-care treatment. Confirmatory scans, as recommended in the modified RANO criteria, were not always available reflecting current clinical practice.
Original languageEnglish
Article numbernoad247
Pages (from-to)902-910
Number of pages9
Issue number5
Early online date14 Jan 2024
Publication statusPublished - 1 May 2024

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© 2024 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology.


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