High-grade glioma, pediatric

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This page contains studies that are specific to pediatric populations. 
*For the more general high-grade glioma category page, follow this link.
*For pediatric low-grade glioma (pLGG), follow this link.
Last updated on 2024-07-23:4 regimens on this page
5 variants on this page
=Guidelines=
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
==NCCN==
*NCCN Guidelines - Pediatric Central Nervous System Cancers
=First-line therapy=
==Temozolomide & RT==
Temozolomide & RT: Temozolomide & Radiation Therapy
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Grill et al. 2018 (HERBY)	2011-2015 	Randomized Phase 2 (C)	Temozolomide, Bevacizumab, RT	Did not meet primary endpoint of EFSMedian EFS: 11.8 vs 8.2 mo
====Preceding treatment====
*Surgical biopsy, partial resection, or total resection
====Chemotherapy====
*Temozolomide (Temodar) as follows:
**Cycle 1 (chemoradiation): 75 mg/m2 PO or IV once per day on days 1 to 42
**Cycles 2 to 13: 150 to 200 mg/m2 PO once per day on days 1 to 5
====Radiotherapy====
*Concurrent radiation therapy as follows:
**Cycle 1: 180 cGy fractions x 30 fractions, for a total dose of 5400 cGy
10-week course, then 28-day cycle for up to 12 cycles
===References===
#HERBY: Grill J, Massimino M, Bouffet E, Azizi AA, McCowage G, Cañete A, Saran F, Le Deley MC, Varlet P, Morgan PS, Jaspan T, Jones C, Giangaspero F, Smith H, Garcia J, Elze MC, Rousseau RF, Abrey L, Hargrave D, Vassal G. Phase II, open-label, randomized, multicenter trial (HERBY) of bevacizumab in pediatric patients with newly diagnosed high-grade glioma. J Clin Oncol. 2018 Apr 1;36(10):951-958. Epub 2018 Feb 7. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC NCT01390948
==VCP==
VCP: Vincristine, CCNU (Lomustine), Prednisone
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Finlay et al. 1995 (CCG-945)	1985-1990 	Phase 3 (C)	8-drug regimen	Did not meet primary endpoint of OS
Note: the exact schedule of vincristine is impossible to discern from Figure 1.
====Preceding treatment====
*Surgery, then adjuvant Vincristine & RT
====Chemotherapy====
*Lomustine (CCNU) 100 mg/m2 IV once on day 1
*Vincristine (Oncovin) 1.5 mg/m2 IV once per day on days 1, 8, 15
====Glucocorticoid therapy====
*Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
42-day cycle for 8 cycles
===References===
#CCG-945: Finlay JL, Boyett JM, Yates AJ, Wisoff JH, Milstein JM, Geyer JR, Bertolone SJ, McGuire P, Cherlow JM, Tefft M, Turski PA, Wara WM, Edwards M, Sutton LN, Berger MS, Epstein F, Ayers G, Allen JC, Packer RJ; Children's Cancer Group. Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. J Clin Oncol. 1995 Jan;13(1):112-23. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
==Vincristine & RT==
Vincristine & RT: Vincristine & Radiation Therapy
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Finlay et al. 1995 (CCG-945)	1985-1990 	Phase 3 (C)	8-drug regimen	Did not meet primary endpoint of OS
====Preceding treatment====
*Surgery
====Chemotherapy====
*Vincristine (Oncovin) 1.5 mg/m2 IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64
====Radiotherapy====
*Concurrent radiation therapy
70-day course
====Subsequent treatment====
*Adjuvant VCP
===References===
#CCG-945: Finlay JL, Boyett JM, Yates AJ, Wisoff JH, Milstein JM, Geyer JR, Bertolone SJ, McGuire P, Cherlow JM, Tefft M, Turski PA, Wara WM, Edwards M, Sutton LN, Berger MS, Epstein F, Ayers G, Allen JC, Packer RJ; Children's Cancer Group. Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. J Clin Oncol. 1995 Jan;13(1):112-23. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
=Recurrent disease, non-curative therapy, non-randomized or retrospective data=
==Temozolomide monotherapy==
===Regimen variant #1, no radiation history===
Study 	Dates of enrollment	Evidence
Nicholson et al. 2007	1998-1999 	Non-randomized
====Chemotherapy====
*Temozolomide (Temodar) 150 to 200 mg/m2 PO once per day on days 1 to 5
**Patients who previously received craniospinal irradiation (CSI) instead received 180 mg/m2 PO once per day on days 1 to 5
28-day cycle for up to 11 cycles
===Regimen variant #2, previous craniospinal irradiation (CSI)===
Study 	Dates of enrollment	Evidence
Nicholson et al. 2007	1998-1999 	Non-randomized
====Chemotherapy====
*Temozolomide (Temodar) 180 mg/m2 PO once per day on days 1 to 5
28-day cycle for up to 11 cycles
===References===
#Nicholson HS, Kretschmar CS, Krailo M, Bernstein M, Kadota R, Fort D, Friedman H, Harris MB, Tedeschi-Blok N, Mazewski C, Sato J, Reaman GH; Children's Oncology Group. Phase 2 study of temozolomide in children and adolescents with recurrent central nervous system tumors: a report from the Children's Oncology Group. Cancer. 2007 Oct 1;110(7):1542-50. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
Category:High-grade glioma regimens
Category:Disease-specific pages
Category:High-grade gliomas
Category:Pediatric neurologic neoplasms