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REVIEW ARTICLE
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Role of temozolomide regimen on survival outcomes in molecularly stratified WHO grade II gliomas: A systematic review


1 John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii
2 Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
3 Universidad Internacional del Ecuador, Escuela de Medicina, Quito, Ecuador

Correspondence Address:
Arash Ghaffari-Rafi,
465 Caledonian Road, Room BL08, London N7 9BA, United Kingdom

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_186_20

Objective/Introduction: Although a critical chemotherapeutic, temozolomide's optimal regimen for 2016 World Health Organization (WHO) Grade II gliomas remains elusive, hence there is utility in not only cataloging survival outcomes of Grade II glioma subtypes against the background of temozolomide regimens, but also quantifying differences in progression-free survival (PFS) and overall survival (OS). Materials and Methods: A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trails was conducted by using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Handbook of Systemic Reviews of Interventions. Results: Each molecular subtype of WHO Grade II glioma had a different temozolomide regimen identified as optimal in prolonging PFS and OS. For PFS, with temozolomide, the 25th, 50th, and 75th percentiles, were as follows (in months), respectively–A-wt II: 6.90, 12.95, and 19.95; A-mt II: 34.45, 36.01, and 39.60; OD II: 37.90, 46.00, and 55.03 (P = 0.016). For OS, the first quartile (25'), median (50'), third quartile (75'), were respectively identified (in months–A-wt II: 21.6 (median; n = 1); A-mt II: 60.6, 85.2, and 109.8; OD II: 86.1, 96.2, and 106.3 (P = 0.37). Conclusion: For each tumor molecular subtype, a different temozolomide regimen was identified as optimal for prolonging PFS and OS. Furthermore, regardless of temozolomide regimen, A-wt II had a significantly shorter PFS than A-mt II and OD-II. Overall, the data can provide useful prognostic insight to patients when making critical treatment decisions. Moreover, by cataloging and assessing survival outcomes per temozolomide regimen, such may facilitate future clinical trial design.


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    -  Ghaffari-Rafi A
    -  Ghaffari-Rafi S
    -  Leon-Rojas J
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