A meta-analysis of temozolomide versus radiotherapy in elderly glioblastoma patients

Yin, Anan; Cai, Sang; Dong, Yu; Zhang, Luhua; Liu, Bo-lin; Cheng, Jinxiang; Zhang, Xuchao

doi:10.1007/s11060-013-1294-0

Cited by 36 publications

(25 citation statements)

References 22 publications

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“…In addition, neither mgmt methylation status nor IDH1/2 mutation status testing was available during the study period. Both markers have been shown to have significant prognostic and predictive value in patients with gbm, and mgmt methylation status in particular has been shown to predict response to temozolomide [22][23][24][25] . In ce.6, elderly patients with mgmtmethylated tumours showed the greatest survival benefit with combined therapy 2 .…”

Section: Figurementioning

confidence: 99%

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Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Norman

Laing

2017

Current Oncology

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Purpose Elderly patients make up a large percentage of the individuals newly diagnosed with glioblastoma (gbm), but they face particular challenges in tolerating standard therapy, and compared with younger patients, they experience significantly shorter survival. We set out to compare clinical characteristics, treatment patterns, and outcomes in a non-elderly group (<65 years) and an elderly group (≥65 years) of patients diagnosed with gbm.Methods This retrospective population-based study used a province-wide cancer registry to identify patients with a new diagnosis of gbm within a 6-year period (2006)(2007)(2008)(2009)(2010)(2011)(2012). Of the 138 patients identified, 56 (40.6%) were 65 years of age or older. Demographic characteristics, treatment patterns, and overall survival (os) in the elderly and non-elderly groups were compared. Predictors of os were determined using multivariate analysis.Results Elderly patients were more likely to present with a poor performance status (Eastern Cooperative Oncology Group ≥ 2), to undergo biopsy without resection, and to receive whole-brain or hypofractionated radiotherapy. Compared with non-elderly patients, the elderly patients were less likely to receive adjuvant temozolomide. Survival time was significantly shorter in the elderly than in the non-elderly patients (7.2 months vs. 11.2 months). In multivariate analysis, surgical resection, hypofractionated radiotherapy (compared with whole-brain or conventional radiotherapy), and chemotherapy were predictive of os in older patients. Among elderly patients receiving radiation, survival was improved with the use of combined therapy compared with the use of radiation only (11.3 months vs. 4.6 months). ConclusionsOverall survival was shorter for elderly patients with gbm than for non-elderly patients; the elderly patients were also less likely to receive intensive surgical or adjuvant therapy. Our population-based analysis demonstrated improved os with surgical resection, hypofractionated radiotherapy, and temozolomide, and supports the results of recent clinical trials demonstrating a benefit for combination chemoradiotherapy in older patients.

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Section: Figurementioning

confidence: 99%

“…In elderly patients who are less likely to tolerate combined chemoradiotherapy, mgmt methylation status might be especially important. The use of temozolomide monotherapy in mgmt-methylated patients is an area of active study in elderly patients with gbm 25 .…”

Section: Figurementioning

confidence: 99%

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Norman

Laing

2017

Current Oncology

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“…In certain cases, concurrent TMZ has been added to HRT, based on the superior outcomes reported with the Stupp protocol (7,8), although it has not yet been established that combining HRT with concurrent TMZ is superior to HRT alone (9). More recently, TMZ was investigated as a single agent and, based on certain genetic factors in the tumor, it may also be an effective treatment option (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

Burton

Ugiliweneza

Woo

et al. 2015

Molecular and Clinical Oncology

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Abstract. The Surveillance, Epidemiology and End Results (SEER) database was used to determine the treatment patterns, outcomes and cost of therapy in elderly patients with glioblastoma multiforme (GBM). The SEER-Medicare linked database was used to identify patients aged >66 years with GBM diagnosed between 1997 and 2009. The patients were stratified by initial treatment following diagnostic surgery (resection or biopsy) into 6 groups as follows: No treatment, standard radiation therapy (SRT) with and without concurrent temozolomide (TMZ), hypofractionated RT (HRT) with and without concurrent TMZ, or TMZ alone. The 3,759 patients identified had a median age of 74 years (range, 66-97 years). A total of ~48% of the patients received SRT without TMZ; ~10% received SRT with concurrent TMZ; ~29% received no treatment; ~10% received HRT without TMZ; ~1% received HRT with TMZ; and <1% received TMZ alone. Untreated patients had a median survival of 2 months (range, 0-89 months). Patients treated with SRT with and without concurrent TMZ had a median survival of 11 and 9 months, respectively (P=0.01). Patients treated with HRT with and without TMZ or TMZ alone had a median survivals of 3 months [adjusted hazard ratio (AHR)=0.48; 95% confidence interval (CI): 0.36-0.66], 4 months (AHR=0.55; 95% CI: 0.49-0.62) and 6 months (AHR=0.43; 95% CI: 0.29-0.62), respectively. The median post-surgery total treatment cost for patients receiving HRT with and without TMZ or TMZ alone was 63,915, 42,834 and 48,298 USD, respectively. Standard RT with concurrent TMZ was associated with improved survival, even in patients aged >75 years. HRT with and without concurrent TMZ and TMZ alone improved survival compared to the no treatment group. Therefore, in certain cases, HRT or TMZ alone may be more cost-effective, with similar survival outcomes. The various treatment options highlight the need for geriatric assessment tools to aid in therapeutic decision making.

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“…Nevertheless, chemotherapy with TMZ alone is put forth as an acceptable alternative to RT in elderly patients with GBM [32,33,34,35]. The NOA trial examined and compared patients who received TMZ-alone ( n = 195) versus RT-alone ( n = 178) for malignant astrocytoma.…”

Section: Discussionmentioning

confidence: 99%

“…Although these trials demonstrated the non-inferiority of TMZ compared to RT in elderly patients; they did not compare the outcome of TMZ when used as an adjuvant treatment to RT. Yin et al [32] also demonstrated the non-inferiority of TMZ to RT-alone in improving the overall survival in elderly, however at an increased risk of grade 3-4 toxicities. Zarnett et al [33], in their systematic review, concluded that elderly patients with MGMT promoter methylation are more likely to receive the greatest benefit from TMZ-alone regimen over RT.…”

Section: Discussionmentioning

confidence: 99%

Temozolomide with or without Radiotherapy in Patients with Newly Diagnosed Glioblastoma Multiforme: A Meta-Analysis

2017

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Background/Aim: The current meta-analysis evaluated the survival outcomes of newly diagnosed glioblastoma patients treated with radiotherapy (RT) alone and with RT + temozolomide (TMZ). Methods: Relevant studies were identified by an extensive literature search in Medline, Current Contents and Cochrane databases by 2 independent reviewers using the terms “glioblastoma multiforme/glioblastoma, TMZ, radiation therapy/RT and survival.” Results: Results revealed a median survival of 13.41-19 months in the combined treatment group, as opposed to 7.7-17.1 months in the RT-alone group. Progression-free survival (PFS) was also significantly different between the 2 groups (RT + TMZ, 6.3-13 months; RT-alone, 5-7.6 months). While there was no significant difference in the 6-month survival and 6-month PFS rates between the RT + TMZ and RT groups (pooled OR 0.690; p = 0.057 and OR 0.429, p = 0.052, respectively), the 1-year survival and 1-year PFS rates showed significant difference (OR 0.469; p = 0.030 and OR 0.245, p < 0.001, respectively). Conclusions: Concomitant RT + TMZ is more effective and improves the overall survival and PFS in patients with newly diagnosed glioblastoma.

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A meta-analysis of temozolomide versus radiotherapy in elderly glioblastoma patients

Cited by 36 publications

References 22 publications

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

Temozolomide with or without Radiotherapy in Patients with Newly Diagnosed Glioblastoma Multiforme: A Meta-Analysis

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