Procarbazine, lomustine, and vincristine (PCV) chemotherapy for anaplasticastrocytoma: A retrospective review of Radiation Therapy Oncology Group protocols comparing survival with carmustine or PCV adjuvant chemotherapy

Purpose: To determine any differences in outcome for patients with anaplast ic astrocytoma (AA) treated with adjuvant carmustine (BCNU) versus procarba zine, lomustine, and vincristine (PCV) chemotherapy. Materials and Methods: The Radiation Therapy Oncology Group (RTOG) database was reviewed for patients with newly diagnosed AA treated according to pro tocols that included either BCNU or PCV adjuvant chemotherapy, All patients were treated with radiation therapy The outcome analysis included overall survival, faking into account patient age, extent of resection, Karnofsky p erformance status (KPS), and treatment group (BCNU v PCV). Stratified and n onstratified Cox proportional hazards models were used, as well as an analy sis using matched cases between the groups. Results: A total of 257 patients were treated with BCNU according to RTOG p rotocols 70-18, 83-02, and 90-06; 175 patients were treated with PCV accord ing to RTOG protocol 94-04. All pretreatment characteristics except KPS wer e well balanced by treatment group; 61% of the BCNU group had a KPS of 90 t o 100 compared with 73% of the PCV group (P = .0075), No statistically sign ificant difference in survival was observed in any age group or by KPS or e xtent of surgery. The stratified analysis also showed no trends for improve d survival by treatment group (P = .40). The Cox model identified only age, KPS, and extent of surgery as important variables influencing survival, no t treatment group. Matching cases between groups using age, KPS, and surger y resulted in 133 matched pairs. No difference in survival was observed (P = .41). In a Cox model in which each matched pair is a strata, there was no difference between groups (P = .20). Conclusion: Using this retrospective analysis, there does not seem fa be an y survival benefit to PCV chemotherapy. Future phase III studies for patien ts with AA may need to consider whether BCNU or PCV is used in the control arm. (C) 1999 by American Society of Clinical Oncology.