Chemotherapy in low-grade gliomas.
OBJECTIVE
This review summarizes the recent studies in adults' diffuse low-grade gliomas (LGGs) chemotherapy, including response assessment and potential predictive biomarkers of chemosensitivity.


RESULTS
Recent studies have confirmed that chemotherapy is an interesting treatment option in LGGs. About 25-50% of LGGs achieve radiological responses with temozolomide or a procarbazine-CCNU-vincristine (PCV) regimen. Clinical and quality-of-life improvements are commonly observed with more than half of the patients with epilepsy, demonstrating a significant reduction of seizure frequency. Dynamic volumetric studies have provided a better description of LGGs evolution after chemotherapy. They have shown that an ongoing volume decrease can be observed many months after chemotherapy discontinuation, particularly after PCV, raising the question of how and for how long should LGGs be treated. New response criteria have been defined by the Response Assessment in Neuro-Oncology group. In addition to 1p/19q codeletion and MGMT promoter methylation, IDH1 mutation might also be a potential predictive biomarker of chemosensitivity.


CONCLUSIONS
It has now been widely accepted that chemotherapy is an interesting treatment option in LGGs. However, several questions remain unanswered regarding its optimal use. Ongoing phase III studies will allow a better delineation of the role of chemotherapy in LGGs and will also help to better determine the potential predictive value of a 1p/19q codeletion, a MGMT promoter methylation and an IDH1 mutation.
Service de Neuro-Oncologie, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.
Aurélien
A
Viaccoz
Alain
A
Lekoubou
François
F
Ducray
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D059248:Chemoradiotherapy; D002986:Clinical Trials as Topic; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D008130:Lomustine / Q000494:pharmacology / Q000627:therapeutic use; D011344:Procarbazine / Q000494:pharmacology / Q000627:therapeutic use; D000077204:Temozolomide; D016896:Treatment Outcome; D014750:Vincristine / Q000494:pharmacology / Q000627:therapeutic use
D011344:Procarbazine; D014750:Vincristine; D008130:Lomustine; D003606:Dacarbazine; D000077204:Temozolomide