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Treatment strategies for glioblastoma in older patients: age is just a number

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Abstract

Background/purpose

Optimal care for elderly patients with glioblastoma (GBM) remains in question due to their exclusion from and underrepresentation in many clinical trials (including EORTC 22,981) as well as their historically poor overall survival.

Methods

A retrospective chart review was conducted at a single high-volume cancer center for newly diagnosed elderly (65 years old or older) GBM patients diagnosed from 2011 through 2017.

Results

A total of 158 newly diagnosed GBM patients aged 65 years and older were identified. One hundred forty-four patients (91.1%) received radiotherapy (RT) and 130 patients (90.3%) received concurrent temozolomide with RT. Sixty-one patients (38.6%) completed concurrent chemoradiation and 6 cycles of adjuvant temozolomide. 23% of patients discontinued temozolomide during concurrent or adjuvant treatment due to side effects or complications of chemotherapy.

With a median follow-up time of 35.0 months, median overall survival (OS) time for the full cohort was 18.6 months, with estimated OS rates of 74.8%, 35.9%, and 9.5% at 1, 2, and 5 years, respectively. On multivariable analysis, higher KPS (p = 0.002, HR 0.46; 95% CI 0.63–0.82), completing planned RT course (p = 0.01, HR 0.29; 95% CI 0.11–0.75), and completing 6 cycles of adjuvant temozolomide (p = 0.01, HR 2.62; 95% CI 1.67–4.12) were independently associated with improved OS.

Conclusions

Our cohort of elderly GBM patients was predominantly treated with standard of care therapy based on EORTC 22,981. Despite their age, these patients generally tolerated treatment well and had favorable outcomes compared to those reported for patients treated on EORTC 22,981. Based on these findings, using advanced age as the basis for treatment de-escalation or as an exclusionary criterion in clinical trials should be discouraged.

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Funding

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Author notes

  1. Michael Youssef and Ethan B. Ludmir have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Unit 431, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA

    Michael Youssef & John F. de Groot

  2. Department of Neurology and Neurosurgery, Baylor College of Medicine, One Baylor Plaza, MS NB302, Houston, TX, 77030, USA

    Ethan B. Ludmir, Jacob J. Mandel, Akash J. Patel, Ali Jalali & Jeffrey Treiber

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1409, P. O. Box 301402, Houston, TX, 77230-1402, USA

    Jimin Wu

  4. Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1422, 1400 Pressler St, FCT6.5000, Houston, TX, 77030, USA

    Ethan B. Ludmir & Mary Frances McAleer

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  1. Michael Youssef
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Contributions

MY (data curation, formal analysis, writing—original draft, writing—review and editing), EBL (data curation, formal analysis, writing - original draft,writing—review and editing), JJM (conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing), JT (data curation, writing—review and editing, AJP (data curation, writing—review and editing), AJ (data curation, writing—review and editing), MFM (conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing), JFG (conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing).

Corresponding author

Correspondence to John F. de Groot.

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Conflict of interest

Dr. John de Groot—Grant or Research Support: Sanofi-Aventis, Astrazeneca, EMD-Serono; Eli Lilly, Novartis, Deciphera Pharmaceuticals, Mundipharma; Paid Consultant: Celldex; Deciphera Pharmaceuticals, AbbVie, FivePrime Therapeutics, Inc., GW Pharma, Carthera, Eli Lilly, Boston Biomedical Inc.,Taiho Pharmaceuticals, Kairos Venture Investments, Syneos Health, Monteris, Agios, Mundipharma, Blue Earth Diagnostics; Advisory Boards: Genentech, Celldex, Foundation Medicine, Inc., Novogen, Deciphera, Astrazeneca, Insys Therapeutics, Kadmon, Merck, Eli Lilly, Novella Clinical, Blue Earth Diagnostics; Other Relevant Financial or Material Interests: DSMB: VBL Therapeutics; DSMB: Novella; VBI Vaccines, Inc.; Stock Ownership: Ziopharm Oncology, Gilead; Company Employment (Spouse): Ziopharm Oncology. None of the other authors have any conflict of interests to report.

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This article does not contain any studies with human participants or animals performed by any of the authors and was a retrospective study performed with approval of the IRB of the respective institutions.

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Youssef, M., Ludmir, E.B., Mandel, J.J. et al. Treatment strategies for glioblastoma in older patients: age is just a number. J Neurooncol 145, 357–364 (2019). https://doi.org/10.1007/s11060-019-03304-x

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