MGMT Gene Silencing and Benefit from Temozolomide in Glioblastoma
Monika E. Hegi, Ph.D., Annie-Claire Diserens, M.Sc., Thierry Gorlia, M.Sc., Marie-France Hamou, Nicolas de Tribolet, M.D., Michael Weller, M.D., Johan M. Kros, M.D., Johannes A. Hainfellner, M.D., Warren Mason, M.D., Luigi Mariani, M.D., Jacoline E.C. Bromberg, M.D., Peter Hau, M.D., René O. Mirimanoff, M.D., J. Gregory Cairncross, M.D., Robert C. Janzer, M.D., and Roger Stupp, M.D.
Background Epigenetic silencing of the MGMT (O6-methylguanineDNAmethyltransferase) DNA-repair gene by promoter methylation compromisesDNA repair and has been associated with longer survival in patientswith glioblastoma who receive alkylating agents.
Methods We tested the relationship between MGMT silencing inthe tumor and the survival of patients who were enrolled ina randomized trial comparing radiotherapy alone with radiotherapycombined with concomitant and adjuvant treatment with temozolomide.The methylation status of the MGMT promoter was determined bymethylation-specific polymerase-chain-reaction analysis.
Results The MGMT promoter was methylated in 45 percent of 206assessable cases. Irrespective of treatment, MGMT promoter methylationwas an independent favorable prognostic factor (P<0.001 bythe log-rank test; hazard ratio, 0.45; 95 percent confidenceinterval, 0.32 to 0.61). Among patients whose tumor containeda methylated MGMT promoter, a survival benefit was observedin patients treated with temozolomide and radiotherapy; theirmedian survival was 21.7 months (95 percent confidence interval,17.4 to 30.4), as compared with 15.3 months (95 percent confidenceinterval, 13.0 to 20.9) among those who were assigned to onlyradiotherapy (P=0.007 by the log-rank test). In the absenceof methylation of the MGMT promoter, there was a smaller andstatistically insignificant difference in survival between thetreatment groups.
Conclusions Patients with glioblastoma containing a methylatedMGMT promoter benefited from temozolomide, whereas those whodid not have a methylated MGMT promoter did not have such abenefit.
Source Information
From the Laboratory of Tumor Biology and Genetics, Department of Neurosurgery (M.E.H., A.-C.D., M.-F.H., N.T.), the Departments of Radiotherapy (R.O.M.) and Neuropathology (R.C.J.), and the Multidisciplinary Oncology Center (R.S.), University Hospital Lausanne, Lausanne; the Department of Neurosurgery, University Hospital Geneva, Geneva (N.T.); the National Center of Competence in Research Molecular Oncology, Swiss Institute for Experimental Cancer Research, Epalinges (M.E.H.); and the Department of Neurosurgery, Inselspital, Bern (L.M.) all in Switzerland; the Data Center, European Organisation for Research and Treatment of Cancer, Brussels (T.G.); the Department of Neurology, University of Tübingen, Tübingen (M.W.), and the Department of Neurology, University of Regensburg, Regensburg (P.H.) both in Germany; the Division of Neuropathology, University Hospital Rotterdam, Rotterdam (J.M.K.), and University Medical Center, Utrecht (J.E.C.B.) both in the Netherlands; the Institute of Neurology, Medical University of Vienna, Vienna, (J.A.H.); and Princess Margaret Hospital, Toronto (W.M.), and the University of Calgary, Calgary, Alta. (J.G.C.) both in Canada.
Address reprint requests to Dr. Hegi at the Laboratory of Tumor Biology and Genetics, Department of Neurosurgery, University Hospital (CHUV), BH19-110, 1011 Lausanne, Switzerland, or at monika.hegi{at}chuv.hospvd.ch.
Treatment of Brain Tumors
Paulino A. C., Teh B. S., Sadeh M., Seiter K., Ashby L., LaRocca R., Ryken T., Aiken R. D., Rutkowski S., Ottensmeier H., Pietsch T., Stupp R., Hegi M. E., DeAngelis L. M.
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N Engl J Med 2005;
352:2350-2353, Jun 2, 2005.
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