000860831 001__ 860831 000860831 005__ 20210130000630.0 000860831 0247_ $$2doi$$a10.1016/S0140-6736(18)31791-4 000860831 0247_ $$2ISSN$$a0023-7507 000860831 0247_ $$2ISSN$$a0099-5355 000860831 0247_ $$2ISSN$$a0140-6736 000860831 0247_ $$2ISSN$$a1474-547X 000860831 0247_ $$2pmid$$apmid:30782343 000860831 0247_ $$2WOS$$aWOS:000458817300026 000860831 0247_ $$2altmetric$$aaltmetric:55507209 000860831 037__ $$aFZJ-2019-01486 000860831 082__ $$a610 000860831 1001_ $$0P:(DE-HGF)0$$aHerrlinger, Ulrich$$b0$$eCorresponding author 000860831 245__ $$aLomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA–09): a randomised, open-label, phase 3 trial 000860831 260__ $$aLondon [u.a.]$$bElsevier$$c2019 000860831 3367_ $$2DRIVER$$aarticle 000860831 3367_ $$2DataCite$$aOutput Types/Journal article 000860831 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1550558854_14885 000860831 3367_ $$2BibTeX$$aARTICLE 000860831 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000860831 3367_ $$00$$2EndNote$$aJournal Article 000860831 520__ $$aBackgroundThere is an urgent need for more effective therapies for glioblastoma. Data from a previous unrandomised phase 2 trial suggested that lomustine-temozolomide plus radiotherapy might be superior to temozolomide chemoradiotherapy in newly diagnosed glioblastoma with methylation of the MGMT promoter. In the CeTeG/NOA-09 trial, we aimed to further investigate the effect of lomustine-temozolomide therapy in the setting of a randomised phase 3 trial.MethodsIn this open-label, randomised, phase 3 trial, we enrolled patients from 17 German university hospitals who were aged 18–70 years, with newly diagnosed glioblastoma with methylated MGMT promoter, and a Karnofsky Performance Score of 70% and higher. Patients were randomly assigned (1:1) with a predefined SAS-generated randomisation list to standard temozolomide chemoradiotherapy (75 mg/m2 per day concomitant to radiotherapy [59–60 Gy] followed by six courses of temozolomide 150–200 mg/m2 per day on the first 5 days of the 4-week course) or to up to six courses of lomustine (100 mg/m2 on day 1) plus temozolomide (100–200 mg/m2 per day on days 2–6 of the 6-week course) in addition to radiotherapy (59–60 Gy). Because of the different schedules, patients and physicians were not masked to treatment groups. The primary endpoint was overall survival in the modified intention-to-treat population, comprising all randomly assigned patients who started their allocated chemotherapy. The prespecified test for overall survival differences was a log-rank test stratified for centre and recursive partitioning analysis class. The trial is registered with ClinicalTrials.gov, number NCT01149109.FindingsBetween June 17, 2011, and April 8, 2014, 141 patients were randomly assigned to the treatment groups; 129 patients (63 in the temozolomide and 66 in the lomustine-temozolomide group) constituted the modified intention-to-treat population. Median overall survival was improved from 31·4 months (95% CI 27·7–47·1) with temozolomide to 48·1 months (32·6 months–not assessable) with lomustine-temozolomide (hazard ratio [HR] 0·60, 95% CI 0·35–1·03; p=0·0492 for log-rank analysis). A significant overall survival difference between groups was also found in a secondary analysis of the intention-to-treat population (n=141, HR 0·60, 95% CI 0·35–1·03; p=0·0432 for log-rank analysis). Adverse events of grade 3 or higher were observed in 32 (51%) of 63 patients in the temozolomide group and 39 (59%) of 66 patients in the lomustine-temozolomide group. There were no treatment-related deaths.InterpretationOur results suggest that lomustine-temozolomide chemotherapy might improve survival compared with temozolomide standard therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. The findings should be interpreted with caution, owing to the small size of the trial. 000860831 536__ $$0G:(DE-HGF)POF3-572$$a572 - (Dys-)function and Plasticity (POF3-572)$$cPOF3-572$$fPOF III$$x0 000860831 588__ $$aDataset connected to CrossRef 000860831 7001_ $$0P:(DE-HGF)0$$aTzaridis, Theophilos$$b1 000860831 7001_ $$0P:(DE-HGF)0$$aMack, Frederic$$b2 000860831 7001_ $$0P:(DE-HGF)0$$aSteinbach, Joachim Peter$$b3 000860831 7001_ $$0P:(DE-HGF)0$$aSchlegel, Uwe$$b4 000860831 7001_ $$0P:(DE-Juel1)165921$$aSabel, Michael$$b5 000860831 7001_ $$0P:(DE-HGF)0$$aHau, Peter$$b6 000860831 7001_ $$0P:(DE-HGF)0$$aKortmann, Rolf-Dieter$$b7 000860831 7001_ $$0P:(DE-HGF)0$$aKrex, Dietmar$$b8 000860831 7001_ $$0P:(DE-HGF)0$$aGrauer, Oliver$$b9 000860831 7001_ $$0P:(DE-HGF)0$$aGoldbrunner, Roland$$b10 000860831 7001_ $$0P:(DE-HGF)0$$aSchnell, Oliver$$b11 000860831 7001_ $$0P:(DE-HGF)0$$aBähr, Oliver$$b12 000860831 7001_ $$0P:(DE-HGF)0$$aUhl, Martin$$b13 000860831 7001_ $$0P:(DE-HGF)0$$aSeidel, Clemens$$b14 000860831 7001_ $$0P:(DE-HGF)0$$aTabatabai, Ghazaleh$$b15 000860831 7001_ $$0P:(DE-HGF)0$$aKowalski, Thomas$$b16 000860831 7001_ $$0P:(DE-HGF)0$$aRingel, Florian$$b17 000860831 7001_ $$0P:(DE-HGF)0$$aSchmidt-Graf, Friederike$$b18 000860831 7001_ $$0P:(DE-HGF)0$$aSuchorska, Bogdana$$b19 000860831 7001_ $$0P:(DE-HGF)0$$aBrehmer, Stefanie$$b20 000860831 7001_ $$0P:(DE-HGF)0$$aWeyerbrock, Astrid$$b21 000860831 7001_ $$0P:(DE-HGF)0$$aRenovanz, Miriam$$b22 000860831 7001_ $$0P:(DE-HGF)0$$aBullinger, Lars$$b23 000860831 7001_ $$0P:(DE-Juel1)143792$$aGalldiks, Norbert$$b24 000860831 7001_ $$0P:(DE-HGF)0$$aVajkoczy, Peter$$b25 000860831 7001_ $$0P:(DE-HGF)0$$aMisch, Martin$$b26 000860831 7001_ $$0P:(DE-HGF)0$$aVatter, Hartmut$$b27 000860831 7001_ $$0P:(DE-HGF)0$$aStuplich, Moritz$$b28 000860831 7001_ $$0P:(DE-HGF)0$$aSchäfer, Niklas$$b29 000860831 7001_ $$0P:(DE-HGF)0$$aKebir, Sied$$b30 000860831 7001_ $$0P:(DE-HGF)0$$aWeller, Johannes$$b31 000860831 7001_ $$0P:(DE-HGF)0$$aSchaub, Christina$$b32 000860831 7001_ $$0P:(DE-HGF)0$$aStummer, Walter$$b33 000860831 7001_ $$0P:(DE-HGF)0$$aTonn, Jörg-Christian$$b34 000860831 7001_ $$0P:(DE-HGF)0$$aSimon, Matthias$$b35 000860831 7001_ $$0P:(DE-HGF)0$$aKeil, Vera C$$b36 000860831 7001_ $$0P:(DE-HGF)0$$aNelles, Michael$$b37 000860831 7001_ $$0P:(DE-HGF)0$$aUrbach, Horst$$b38 000860831 7001_ $$0P:(DE-HGF)0$$aCoenen, Martin$$b39 000860831 7001_ $$0P:(DE-HGF)0$$aWick, Wolfgang$$b40 000860831 7001_ $$0P:(DE-HGF)0$$aWeller, Michael$$b41 000860831 7001_ $$0P:(DE-HGF)0$$aFimmers, Rolf$$b42 000860831 7001_ $$0P:(DE-HGF)0$$aSchmid, Matthias$$b43 000860831 7001_ $$0P:(DE-HGF)0$$aHattingen, Elke$$b44 000860831 7001_ $$0P:(DE-HGF)0$$aPietsch, Torsten$$b45 000860831 7001_ $$0P:(DE-HGF)0$$aCoch, Christoph$$b46 000860831 7001_ $$0P:(DE-HGF)0$$aGlas, Martin$$b47 000860831 773__ $$0PERI:(DE-600)1476593-7$$a10.1016/S0140-6736(18)31791-4$$gVol. 393, no. 10172, p. 678 - 688$$n10172$$p678 - 688$$tThe lancet <London>$$v393$$x0140-6736$$y2019 000860831 8564_ $$uhttps://juser.fz-juelich.de/record/860831/files/Herrlinger_2019_Post%20Print_Lancet_Lomustine-temozolomide%20combination%20therapy%20versus%20standard%20temozolomide%20therapy.pdf$$yRestricted 000860831 8564_ $$uhttps://juser.fz-juelich.de/record/860831/files/Herrlinger_2019_Post%20Print_Lancet_Lomustine-temozolomide%20combination%20therapy%20versus%20standard%20temozolomide%20therapy.pdf?subformat=pdfa$$xpdfa$$yRestricted 000860831 909CO $$ooai:juser.fz-juelich.de:860831$$pVDB 000860831 9101_ $$0I:(DE-588b)5008462-8$$6P:(DE-Juel1)143792$$aForschungszentrum Jülich$$b24$$kFZJ 000860831 9131_ $$0G:(DE-HGF)POF3-572$$1G:(DE-HGF)POF3-570$$2G:(DE-HGF)POF3-500$$3G:(DE-HGF)POF3$$4G:(DE-HGF)POF$$aDE-HGF$$bKey Technologies$$lDecoding the Human Brain$$v(Dys-)function and Plasticity$$x0 000860831 9141_ $$y2019 000860831 915__ $$0StatID:(DE-HGF)0420$$2StatID$$aNationallizenz 000860831 915__ $$0StatID:(DE-HGF)0200$$2StatID$$aDBCoverage$$bSCOPUS 000860831 915__ $$0StatID:(DE-HGF)0300$$2StatID$$aDBCoverage$$bMedline 000860831 915__ $$0StatID:(DE-HGF)0310$$2StatID$$aDBCoverage$$bNCBI Molecular Biology Database 000860831 915__ $$0StatID:(DE-HGF)0600$$2StatID$$aDBCoverage$$bEbsco Academic Search 000860831 915__ $$0StatID:(DE-HGF)0030$$2StatID$$aPeer Review$$bASC 000860831 915__ $$0StatID:(DE-HGF)0100$$2StatID$$aJCR$$bLANCET : 2017 000860831 915__ $$0StatID:(DE-HGF)0199$$2StatID$$aDBCoverage$$bClarivate Analytics Master Journal List 000860831 915__ $$0StatID:(DE-HGF)0110$$2StatID$$aWoS$$bScience Citation Index 000860831 915__ $$0StatID:(DE-HGF)0150$$2StatID$$aDBCoverage$$bWeb of Science Core Collection 000860831 915__ $$0StatID:(DE-HGF)0111$$2StatID$$aWoS$$bScience Citation Index Expanded 000860831 915__ $$0StatID:(DE-HGF)1110$$2StatID$$aDBCoverage$$bCurrent Contents - Clinical Medicine 000860831 915__ $$0StatID:(DE-HGF)1030$$2StatID$$aDBCoverage$$bCurrent Contents - Life Sciences 000860831 915__ $$0StatID:(DE-HGF)1050$$2StatID$$aDBCoverage$$bBIOSIS Previews 000860831 915__ $$0StatID:(DE-HGF)9950$$2StatID$$aIF >= 50$$bLANCET : 2017 000860831 920__ $$lyes 000860831 9201_ $$0I:(DE-Juel1)INM-3-20090406$$kINM-3$$lKognitive Neurowissenschaften$$x0 000860831 980__ $$ajournal 000860831 980__ $$aVDB 000860831 980__ $$aI:(DE-Juel1)INM-3-20090406 000860831 980__ $$aUNRESTRICTED