How do you choose between adjuvant PCV vs temozolomide in high risk oligodendroglioma with IDH mutation and 1p/19q co deletion?

In our practice, we typically offer procarbazine/lomustine (with or without vincristine) to all patients with high risk oligodendroglioma, IDH mutated, 1p/19q codeleted. Temozolomide based on the Stupp regimen is used as an alternative when there are specific concerns for PCV related toxicity or strong patient preference. That being said, patients should ideally be enrolled onto the CODEL trial which randomizes patients with 1p/19q codeleted gliomas between these two treatments.

The rationale behind the use of PCV is very clear, based on the data from RTOG 9802 demonstrating a clear improvement in survival for patients with high risk (age > 40 or less than a gross total resection) grade 2 gliomas. Subset analysis indicated that patients with...