Brain pathways symbolizing treatment options for oligodendroglioma.

PCV vs. Temozolomide: Which Chemo is the Right Choice for Oligodendroglioma?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"Navigating the complexities of high-grade oligodendroglioma treatment: A practical guide for patients and caregivers."

Oligodendroglioma, a type of brain tumor, presents a unique treatment landscape. Over the last decade, research has demonstrated that combining chemotherapy with radiation therapy significantly improves survival rates for individuals diagnosed with this condition. However, the optimal chemotherapy regimen remains a topic of ongoing discussion among experts.

While initial clinical trials favored PCV (procarbazine, CCNU, and vincristine), temozolomide (TMZ) has emerged as a potentially effective alternative due to its ease of administration and generally better tolerance. The lack of direct comparative data between PCV and TMZ has led to varied practices in treatment approaches.

This article aims to provide a clear understanding of the PCV vs TMZ debate, offering insights to help patients and their families navigate this complex decision-making process. By exploring the arguments for each regimen, we empower you to engage in informed discussions with your healthcare team and make the best choice for your individual circumstances.

PCV: The Data-Driven Choice for Oligodendroglioma

Brain pathways symbolizing treatment options for oligodendroglioma.

The established treatment paradigm for oligodendroglioma involves addressing the chromosomal arms 1p/19q. The pivotal RTOG 9402 and EORTC 26951 studies provide compelling evidence for the benefits of PCV chemotherapy in conjunction with radiation therapy. These trials demonstrated significant improvements in both progression-free survival (PFS) and overall survival (OS) compared to radiation alone.

The RTOG 9402 study revealed that treatment with PCV plus RT doubled median overall survival in patients with 1p/19q-codeleted tumors (14.7 years vs. 7.3 years, HR 0.59, P = .03). Similarly, EORTC 26951 demonstrated a significant increase in OS with RT/PCV compared to RT alone (42.3 vs 30.6 months, HR 0.75).

RTOG 9402: Doubled median OS in 1p/19q-codeleted tumors with PCV + RT.
EORTC 26951: Significant OS increase with RT/PCV vs. RT alone.
RTOG 9802 & NOA-04: Reinforced PCV's benefit as adjuvant therapy.

While the CODEL trial aims to provide clarity, the data supporting PCV remains strong, especially in high-risk patients. However, TMZ may be considered for patients unable to tolerate PCV's side effects.

Making an Informed Choice: Partnering with Your Healthcare Team

Ultimately, the decision between PCV and temozolomide requires careful consideration of individual patient factors, potential side effects, and the latest research findings. While PCV has a strong base in clinical trial data, TMZ offers a more convenient and tolerable option for some individuals.

It's crucial to have an open and honest discussion with your oncologist and healthcare team to weigh the pros and cons of each regimen in your specific case. Factors such as tumor genetics (1p/19q codeletion status), overall health, and personal preferences should all be taken into account.

As research continues and the results of ongoing trials like CODEL become available, the treatment landscape for oligodendroglioma will continue to evolve. By staying informed and actively participating in your care, you can make the most empowered decisions possible.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/nop/npy044, Alternate LINK

Title: Neuro-Oncology Clinical Debate: Pcv Or Temozolomide In Combination With Radiation For Newly Diagnosed High-Grade Oligodendroglioma

Subject: Medicine (miscellaneous)

Journal: Neuro-Oncology Practice

Publisher: Oxford University Press (OUP)

Authors: Michael W Ruff, Jan C Buckner, Derek R Johnson, Martin J Van Den Bent, Marjolein Geurts

Published: 2018-11-03

Everything You Need To Know

What is PCV chemotherapy and why is it considered in the treatment of oligodendroglioma?

PCV, which stands for procarbazine, CCNU, and vincristine, has shown significant benefits in conjunction with radiation therapy for individuals diagnosed with oligodendroglioma. Landmark studies like RTOG 9402 and EORTC 26951 have demonstrated notable improvements in both progression-free survival and overall survival when PCV is used alongside radiation compared to radiation therapy alone, particularly in tumors with 1p/19q codeletion.

How does temozolomide (TMZ) compare to PCV as a chemotherapy option for oligodendroglioma, and when might it be preferred?

Temozolomide (TMZ) presents an alternative to PCV in the treatment of oligodendroglioma. While PCV has a strong foundation in clinical trial data, temozolomide is generally better tolerated and easier to administer. Temozolomide may be considered for patients who cannot tolerate the side effects associated with PCV. However, direct comparative data between PCV and temozolomide is lacking, leading to variations in treatment approaches.

Can you explain the significance of the RTOG 9402 and EORTC 26951 studies in the context of PCV treatment for oligodendroglioma?

The RTOG 9402 study revealed that treatment with PCV plus radiation therapy doubled median overall survival in patients with 1p/19q-codeleted tumors (14.7 years vs. 7.3 years). The EORTC 26951 study also demonstrated a significant increase in overall survival with radiation therapy and PCV compared to radiation alone (42.3 vs 30.6 months). These findings highlight the importance of considering PCV, especially for individuals with specific genetic markers associated with oligodendroglioma.

What factors should patients and their healthcare team consider when deciding between PCV and temozolomide for oligodendroglioma?

The decision between PCV and temozolomide should be made through careful consideration of individual patient factors, potential side effects, and the latest research findings, in partnership with the healthcare team. While PCV has substantial clinical trial data supporting its use, temozolomide offers a more convenient and tolerable option for some individuals. Factors such as tolerance to side effects, tumor genetics, and overall health should be discussed with your healthcare team to determine the most appropriate treatment plan.

What is the role of 1p/19q codeletion in oligodendroglioma, and how does it influence the choice of chemotherapy treatment?

Chromosomal arms 1p and 19q are significant genetic markers in oligodendroglioma. The RTOG 9402 study showed that PCV combined with radiation doubled the median overall survival in patients with tumors that had a 1p/19q codeletion. This codeletion is associated with a more favorable response to chemotherapy. Identifying the presence or absence of this codeletion is crucial for guiding treatment decisions and predicting prognosis in oligodendroglioma.