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FYIer on New Standard for Older Patients With Glioblastoma MedPage Today 06.10.2016

Short-course radiotherapy plus temozolomide led to significant improvement in overall and progression-free survival (PFS) compared with radiation alone in older patients with glioblastoma, a randomized trial showed.
Median survival was 9.3 months with combined treatment versus 7.6 months for radiotherapy. Median PFS improved from 3.9 months to 5.3 months with combined-modality therapy.

Biomarker analysis for a subgroup of patients showed that patients with tumors expressing the MGMT methylation promoter benefited the most from combined treatment, James R. Perry, MD, of Sunnybrook Health Sciences Center in Toronto, reported here at the American Society of Clinical Oncology (ASCO) meeting.
"Although the differences in median survival seem modest, temozolomide significantly increased the chances of surviving 2 or 3 years," said Perry. "For an individual patient, that can mean being able to be part of another family holiday or celebration."
"Oncologists now have evidence to consider radiotherapy with temozolomide in all newly diagnosed elderly patients with glioblastoma," he added.
The addition of temozolomide also added more adverse events, particularly nausea, vomiting, and constipation, but quality of life assessments showed no significant differences between the two treatment arms.
The results are important because they pertain to the patient population most affected by glioblastoma, said ASCO expert Brian Alexander, MD, of Dana-Farber Cancer Institute in Boston.

"It's good to have an option to offer patients that we know can have a positive impact," said Alexander. However, he cautioned that clinicians and patients still need to weigh the anticipated benefits against the toxicities that can be expected from more intense treatment.
The results will have the effect of extending standard of care to all adults, regardless of age. Glioblastoma disproportionately affects older individuals, as the median age at diagnosis is 64. Standard of care consists of 6 weeks of radiation therapy in combination with temozolomide. However, that standard was established on the basis of a randomized trial that included no patients ≥70 and few who were older than 65, said Perry.
Clinical trials of glioblastoma in older patients have been limited to comparisons of different radiation therapy schedules and of radiotherapy alone versus temozolomide alone. Oncologists have had no evidence-based options for combined-modality treatment of older patients with glioblastoma, Perry continued.

http://www.medpagetoday.com/MeetingCoverage/ASCO/58451?xid=nl_mpt_DHE_2016-06-11&eun=g824783d0r

unabridged version
Perry JR, et al "A phase III randomized controlled trial of short-course radiotherapy with or without concomitant and adjuvant temozolomide in elderly patients with glioblastoma (CCTG CE.6, EORTC 26062-22061, TROG 08.02, NCT00482677)" ASCO 2016; Abstract LBA2