Clinical Study - Patient Study

Journal of Neuro-Oncology

, Volume 99, Issue 1, pp 89-94

First online:

Up-front temozolomide in elderly patients with glioblastoma

  • Florence Laigle-DonadeyAffiliated withService de Neurologie Mazarin, Hôpital de la Salpêtrière Email author 
  • , Dominique Figarella-BrangerAffiliated withService d’Anatomo-Pathologie, Hôpital de la Timone
  • , Olivier ChinotAffiliated withService d’Oncologie, Hôpital de la Timone
  • , Luc TaillandierAffiliated withService de Neurologie, Hôpital Central
  • , Stéphanie Cartalat-CarelAffiliated withService de Neurologie, Hôpital Neurologique Pierre Wertheimer
  • , Jérôme HonnoratAffiliated withService de Neurologie, Hôpital Neurologique Pierre Wertheimer
  • , Gentian KaloshiAffiliated withService de Neurologie Mazarin, Hôpital de la Salpêtrière
  • , Jean-Yves DelattreAffiliated withService de Neurologie Mazarin, Hôpital de la Salpêtrière
  • , Marc SansonAffiliated withService de Neurologie Mazarin, Hôpital de la Salpêtrière

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Abstract

Upfront temozolomide (TMZ) is often proposed for elderly patients with malignant gliomas as an alternative to radiotherapy (RT). A recent randomized trial showed that RT provides a survival benefit in elderly glioblastoma patients (≥70 years) with good performance status (KPS ≥ 70) compared with supportive care alone (median survival (MS) = 29.1 vs. 16.9 weeks). We retrospectively analyzed all patients who were eligible for this trial, but who refused to participate and were finally treated with TMZ alone. Thirty-nine eligible patients (median age: 75 years (range 70–83), median KPS: 70 (range 70–80), histologically proven glioblastomas) were treated up-front with oral TMZ for 1–12 cycles (mean = 5). One complete response and 10 partial responses were observed. Overall median survival (MS) was 36 weeks and median progression-free survival (PFS) was 20 weeks for the whole group. MS was 27.4 weeks and PFS was 19.5 weeks for the 27 patients that did not receive second-line treatment at progression. Eight grade III/IV toxicities (seven hematologic, one gastro-intestinal) were seen, but no treatment-related deaths were observed. These preliminary results support further randomized studies comparing TMZ with RT.

Keywords

Glioblastoma Elderly Chemotherapy