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01-07-2021 | Medulloblastoma | Clinical Study

What does a non-response to induction chemotherapy imply in high-risk medulloblastomas?

Authors: Jihane Adelon, Christelle Dufour, Stéphanie Foulon, Julien Masliah Planchon, David Meyronnet, Franck Bourdeaut, Gilles Palenzuela, Fanny Fouyssac, Sandra Raimbault, Emilie De Carli, Sébastien Klein, Anne Pagnier, Anne-Isabelle Bertozzi, Angélique Rome, Audrey David, Sylvie Chabaud, Cécile Faure-Conter

Published in: Journal of Neuro-Oncology | Issue 3/2021

Abstract

Purpose

High-risk medulloblastomas (HR-MB) may not respond to induction chemotherapy, with either post-induction stable (SD) or progressive disease (PD). There is no consensus regarding their optimal management.

Methods

A retrospective, multicentre study investigated patients with non-responder HR-MB treated according to the PNET HR + 5 protocol (NCT00936156) between 01/01/2009 and 31/12/2018. After two courses of etoposide and carboplatin (induction), patients with SD or PD were analyzed. Upon clinician’s decision, the PNET HR + 5 protocol was either pursued with tandem high-dose chemotherapy (HDCT) and craniospinal irradiation (CSI) (continuation group) or it was modified (switched group).

Results

Forty-nine patients were identified. After induction, 37 patients had SD and 12 had PD. The outcomes were better for the SD group: the 5-y PFS and OS were 52% (95% CI 35–67) and 70% (95% CI 51–83), respectively, in the SD group while the 2-y PFS and OS were 17% (95% CI 3–41) and 25% (95% CI 6–50), respectively, in the PD group (p < 0.0001). The PNET HR + 5 strategy was pursued for 3 patients in the PD group, of whom only one survived. In the SD group, it was pursued for 24/37 patients whereas 13 patients received miscellaneous treatments including a 36 Gy CSI in 12 cases. Despite that continuation and switched group were well-balanced for factors impacting the outcomes, the latter were better in the continuation group than in the switched group: the 5-y PFS were 78% (95% CI 54–90) versus 0% (p < 0.001), and the 5-y OS were 78% (95% CI 54–90) versus 56% (95% CI 23–79) (p = 0.0618) respectively. In the SD group, multivariate analysis revealed that MYC amplification, molecular group 3, and a switched strategy were independent prognostic factors for progression.

Conclusion

Patients with post-induction SD may benefit from HDCT and CSI, whereas patients with early PD will require new therapeutic approaches.

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Title: What does a non-response to induction chemotherapy imply in high-risk medulloblastomas?
Authors: Jihane Adelon
Christelle Dufour
Stéphanie Foulon
Julien Masliah Planchon
David Meyronnet
Franck Bourdeaut
Gilles Palenzuela
Fanny Fouyssac
Sandra Raimbault
Emilie De Carli
Sébastien Klein
Anne Pagnier
Anne-Isabelle Bertozzi
Angélique Rome
Audrey David
Sylvie Chabaud
Cécile Faure-Conter
Publication date: 01-07-2021
Publisher: Springer US
Keywords: Medulloblastoma
Medulloblastoma
Medulloblastoma
Cytostatic Therapy
Published in: Journal of Neuro-Oncology / Issue 3/2021
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-021-03777-9

At a glance: The STEP trials

Springer Medicine

What does a non-response to induction chemotherapy imply in high-risk medulloblastomas?

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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