Evidence map›Paper›PMID 37728779›Full record

ArticleJournal of neuro-oncology2023

Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses.

Thomas Zeyen, Daniel Paech, Johannes Weller, Niklas Schäfer, Theophilos Tzaridis, Cathrina Duffy, Louisa Nitsch, Matthias Schneider, Anna-Laura Potthoff, Joachim Peter Steinbach and 15 more

Erratum issuedAbstract read
In one paragraph

Article in Journal of neuro-oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

25 authors.

Thomas Zeyen *Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Daniel Paech *Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
Johannes WellerDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Niklas SchäferDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Theophilos TzaridisDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Cathrina DuffyDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Louisa NitschDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Matthias SchneiderDepartment of Neurosurgery, University Hospital Bonn, Bonn, Germany.
Anna-Laura PotthoffDepartment of Neurosurgery, University Hospital Bonn, Bonn, Germany.
Joachim Peter SteinbachDr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany.
Peter HauDepartment of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany.
Uwe SchlegelDepartment of Neurology, Klinik Hirslanden, Zürich, Switzerland.
Clemens SeidelDepartment of Radiation Oncology, University of Leipzig, Leipzig, Germany.
Dietmar KrexDepartment of Neurosurgery, Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
Oliver GrauerDepartment of Neurology, University of Münster, Münster, Germany.
Roland GoldbrunnerCenter of Neurosurgery Department of General, Neurosurgery University of Cologne, Cologne, Germany.
Pia Susan ZeinerDr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany.
Ghazaleh TabatabaiDepartment of Neurology and Interdisciplinary Neuro-Oncology, Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, HertieTübingen, Germany.
Norbert GalldiksDepartment of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany and Research Center Juelich, Inst. of Neuroscience and Medicine (INM-3), Juelich, Germany.
Walter StummerDepartment of Neurosurgery, University of Münster, Münster, Germany.
Elke HattingenDepartment of Neuroradiology, University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany.
Martin GlasDivision of Clinical Neurooncology, Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany.
Alexander RadbruchDepartment of Neuroradiology, University Hospital Bonn, Bonn, Germany.
Ulrich HerrlingerDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
Christina SchaubDivision of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany. Christina.schaub@ukbonn.de.ORCID http://orcid.org/0000-0002-5257-4183

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIn the randomized CeTeG/NOA-09 trial, lomustine/temozolomide (CCNU/TMZ) was superior to TMZ therapy regarding overall survival (OS) in MGMT promotor-methylated glioblastoma. Progression-free survival (PFS) and pseudoprogression rates (about 10%) were similar in both arms. Further evaluating this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at first progression according to modified RANO criteria (mRANO).

methodsWe classified the patients of the CeTeG/NOA-09 trial according to long vs. short PPS employing a cut-off of 18 months and compared baseline characteristics and survival times. In patients with available MRIs and confirmed progression, the increase in T

resultsPatients with long PPS in the CCNU/TMZ arm had a particularly short PFS (5.6 months). PFS in this subgroup was shorter than in the long PPS subgroup of the TMZ arm (11.1 months, p = 0.01). At mRANO-defined progression, patients of the CCNU/TMZ long PPS subgroup had a significantly higher increase of mean ADC values (p = 0.015) and a tendency to a stronger volumetric increase in T

conclusionThe combination of survival and MRI analyses identified a subgroup of CCNU/TMZ-treated patients with features that sets them apart from other patients in the trial: short first PFS despite long PPS and significant increase in mean ADC values upon mRANO-defined progression. The observed pattern is compatible with the features commonly observed in pseudoprogression suggesting mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of CeTeG/NOA-09.

Indexed as

Brain NeoplasmsGlioblastomaAntineoplastic Agents, AlkylatingDacarbazineHumansLomustineMagnetic Resonance ImagingTemozolomideAntineoplastic Agents, AlkylatingDacarbazineLomustineTemozolomideGlioblastomaMGMT promotor methylationMRIProgressionPseudoprogression

Identifiers

PMID37728779
PMCPMC10589172

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.