PCV Regimen in Glioma

Standard Dosing Protocol

The American Society of Clinical Oncology recommends a PCV regimen consisting of procarbazine 60 mg/m² orally daily on days 8-21, lomustine 110 mg/m² orally once on day 1, and vincristine 1.4 mg/m² IV on days 8 and 29, administered in 8-week cycles for a total of six cycles, for adult patients with anaplastic oligodendroglioma or anaplastic astrocytoma 1

For IDH-mutant, 1p19q-codeleted anaplastic oligodendroglioma, the National Comprehensive Cancer Network recommends radiation therapy with 59.4 Gy in 33 fractions at five fractions per week, followed by adjuvant PCV using the standard dosing, which is a Category 1 recommendation based on significant overall survival benefit (HR 0.56 for OS in 1p19q-codeleted tumors) 1, 2
The 1p19q codeletion confers both better prognosis and superior response to PCV (OS HR 0.21, P=0.029) in patients with anaplastic oligodendroglioma 1
For IDH-mutant, 1p19q non-codeleted anaplastic astrocytoma, the American Society of Clinical Oncology recommends radiation therapy with 59.4 Gy in 33 fractions of 1.8 Gy, and adjuvant temozolomide is preferred over PCV (150-200 mg/m² days 1-5 every 4 weeks for maximum 12 months) 1
PCV remains a Category 2A alternative for IDH-mutant, 1p19q non-codeleted anaplastic astrocytoma, with lesser benefit compared to oligodendroglioma (OS HR 0.38, P=0.013 for non-codeleted tumors) 1, 2

Grade 3/4 hematologic adverse events occur in 56% of patients during PCV, with the most common being myelosuppression with thrombocytopenia (70.4% in standard PCV), and 20% discontinue due to toxicity 2
The National Comprehensive Cancer Network recommends checking complete blood counts before each cycle, and delaying treatment if absolute neutrophil count <1,500/μL or platelets <100,000/μL 2

Temozolomide has a similar efficacy to PCV in oligodendroglioma, but with better tolerability, and is preferred for 1p19q non-codeleted tumors 1, 3, 4

The PCV recommendations are based on Level I evidence from two landmark randomized trials: EORTC 26951 and RTOG 9402, with long-term follow-up confirming sustained OS benefit, and consistent molecular subgroup analyses showing 1p19q codeletion predicts PCV benefit 1, 2