Temozolomide With Radiotherapy for Glioblastoma Provides Some Survival Benefit in Elderly

The addition of temozolomide to short-course radiotherapy in elderly patients with glioblastoma was associated with some survival benefit compared with radiotherapy alone, according to a paper published in the New England Journal of Medicine.¹

“We anticipate this combined therapy will be the treatment strategy broadly adopted around the world for patients 65 and older because it makes a significant difference in the course of this terrible disease,” said co-author Normand Laperriere, MD, of Princess Margaret Cancer Centre in Toronto, in a statement.²

Treating younger patients with temozolomide along with standard radiotherapy for glioblastoma has been tied to improved survival, according to the authors. 

Elderly patients are typically treated with shorter courses of radiotherapy alone, and whether this combination was beneficial in elderly patients with glioblastoma was previously unknown. Investigators randomized patients aged 65 years or older with a new diagnosis of glioblastoma to undergo radiotherapy alone at 40 Gy in 15 fractions or radiotherapy with temozolomide. 

The study included 281 patients in each group with a median age of 73 years (range, 65 to 90 years). Overall, the median survival was longer in the radiotherapy plus temozolomide group compared with radiotherapy alone group (9.3 months vs 7.6 months; hazard ratio [HR] for death 0.67; 95% CI, 0.56-0.80; P <.001). Likewise, the radiotherapy plus temozolomide group demonstrated improvements in median progression-free survival (5.3 months vs 3.9 months; HR 0.50; 95% CI, 0.41-0.60; P <.001).

Participants with methylated O⁶-methylguanine-DNA methyltransferase (MGMT) status treated with radiotherapy plus temozolomide also saw improvements in overall survival (13.5 months vs 7.7 months; HR 0.53; 95% CI, 0.38-0.73; P <.001). The groups had similar measures for quality of life.¹

“The drug is so well tolerated, there is no downside in administering it to all glioblastoma patients. Thankfully in such a terrible disease, at least we have therapies that are easy on the patient and easy to take,” Dr Laperriere continued.²

References

1. Perry JR, Laperriere N, O’Callaghan CJ, et al. Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med. 2017;376(11):1027-1037.

2. Glioblastoma clinical trial shows combined therapy extends life for patients 65 and older [news release]. Toronto, Canada: University Health Network; March 16, 2017. http://www.uhn.ca/corporate/News/PressReleases/Pages/glioblastoma_clinical_trial_shows_combined_therapy_extends_life_for_patients_65_and_older.aspx. Accessed March 20, 2017.