CNS High Grade Gliomas

Question 1

What kind of agent is temozolamide?

Answer 1

Alkylating agent

Question 2

Tell me about mgmt function and methylation?

Answer 2

A protein that removes DNA damage
If the gene is methylated it silences it and NO LONGER Able to repair
More MGMT methylation better response to chemo and DXT

Question 3

If you have a glioblastoma is it better to have a methylated or unmethylated MGMT gene for prognosis?

Answer 3

Methylated, as it silences the gene

Question 4

In a grade 2 or 3 glioma is IDH1 mutation good or bad?

Answer 4

Good

Question 5

How often do you see IDH1 mutations in primary glioblastoma?

Answer 5

Never

Question 6

What is the mgt of glioblastoma?

Answer 6

Everyone gets
Debulking
DXT (60 Gy)
Concomitant TMZ 75 mg/m2 daily

Adjuvant TMZ 150 mg/m2 days 1-5 every 28 days up to 6 cycles

Question 7

What is the management of grade 3 glioma?

Answer 7

Everyone gets DXT

Chemo (adj PCV) only for 1p19q codeleted

Question 8

What is the management of grade 3 and 4 gliomas in the over 70s?

Answer 8

If poor PS BSC
Good PS:
-methylated MGMT give TMZ alone
-unmethylated MGMT just DXT alone