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Brain Tumors

We review the current data regarding the prognostic and predictive value of IDH mutation and 1p/19q codeletion in gliomas. We also discuss possible management algorithms using these biomarkers to tailor surgical and adjuvant therapy for specific diffuse gliomas.

Brain Tumors

Significant progress has been made in defining molecular signatures in diffuse gliomas. The clinically significant genetic alterations identified to date probably represent the tip of the iceberg, since new, potentially significant biomarkers are continuously described.

We review the current data regarding the prognostic and predictive value of IDH mutation and 1p/19q codeletion in gliomas. We also discuss possible management algorithms using these biomarkers to tailor surgical and adjuvant therapy for specific diffuse gliomas.

Results of two phase III trials, presented at ASCO, on the addition of bevacizumab (Avastin) to standard therapy in newly diagnosed glioblastoma found that the drug added no benefit.

In light of the high bar that must be met for results to be truly practice-changing, and of the long period of time before survival results are mature in an indolent disease, the primary endpoint for clinical trials in anaplastic oligodendroglial tumors needs rethinking.

A turning point in therapy followed the observation that patients with AO tumors with chromosome 1p and 19q codeletion had better outcomes when treated with irradiation and PCV than did non-codeleted anaplastic oligodendroglioma patients.

Although important questions still remain regarding chemotherapy choice, sequence, and dosing, the answers to which will require additional large phase III trials, radiotherapy alone is no longer appropriate therapy for 1p/19q codeleted anaplastic oligodendrogliomas.

The combination of whole-brain radiation therapy and the EGFR inhibitor erlotinib showed a promising response rate and was well tolerated in a new phase II trial of patients with brain metastases from non-small-cell lung cancer.

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