Treatment of Older Adult Patients with Glioblastoma: Moving towards the Inclusion of a Comprehensive Geriatric Assessment for Guiding Management

Abstract

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, and over half of patients with newly diagnosed GBM are over the age of 65. Management of glioblastoma in older patients includes maximal safe resection followed by either radiation, chemotherapy, or combined modality treatment. Despite recent advances in the treatment of older patients with GBM, survival is still only approximately 9 months compared to approximately 15 months for the general adult population, suggesting that further research is required to optimize management in the older population. The Comprehensive Geriatric Assessment (CGA) has been shown to have a prognostic and predictive role in the management of older patients with other cancers, and domains of the CGA have demonstrated an association with outcomes in GBM in retrospective studies. Furthermore, the CGA and other geriatric assessment tools are now starting to be prospectively investigated in older GBM populations. This review aims to outline current treatment strategies for older patients with GBM, explore the rationale for inclusion of geriatric assessment in GBM management, and highlight recent data investigating its implementation into practice.

Treatment Patterns and Outcomes of Patients with Grade 4 Glioma Treated with Radiation during the COVID-19 Pandemic

“…For elderly patients with grade 4 glioma, though the standard of care involves short-course hypofractionated radiation with concurrent and adjuvant temozolomide [ 30 ], there is significant variability in the management of this heterogenous population, and prognosis remains poor. Post-operative adjuvant treatment can range from the standard of care to radiation alone (whether it be hypofractionated radiation or palliative course radiation), to temozolomide alone, to best supportive care, and is largely dependent on performance status and O 6 -methylguanine DNA-methyltransferase (MGMT) methylation status [ 31 ]. Therefore, if the elderly patients in our cohort were presenting later with more severe symptoms, they may have been less likely to be offered treatment.…”

Bioenergetic Profiling in Glioblastoma Multiforme Patients with Different Clinical Outcomes

“…Herein, we employed mass spectrometry-based untargeted plasma metabolomics to gain insights into the rewired metabolic landscape of GBM patients with different clinical outcomes, response to treatment, and disease severity. To avoid selection biases, instead of a population-based estimate, taking into account the sample size of this study and the median OS, 12 months was the cut-off value set for the low- and high-risk groups, as also reported by pivotal studies (RT + TMZ) in GBM and/or clinical trials [ 46 , 47 , 48 ]. To this end, we also interrogated GBM plasma metabotypes and the informative relationships through which metabolites are connected by a mixed-methods content analysis, followed by queries in the Human Metabolome Database (HMDB) [ 28 ], the Metabolomics Workbench, (accessed on 9 October 2020, 9 October 2021 and 29 December 2022) and Metabolights (MTBLS858, MTBLS730, MTBLS3873, MTBLS1558, MTBLS4708) [ 29 ].…”

A 3-miRNA Signature Enables Risk Stratification in Glioblastoma Multiforme Patients with Different Clinical Outcomes

“…Importantly, our findings show that we can extract a distinct miRNA expression profile for each individual, which reflects disease severity. To avoid selection biases, considering the sample size of this study, instead of a population-based estimate, 12 months was the cut-off value set for the low- and high-risk groups, as reported by pivotal studies (RT+TMZ) in GBM and/or clinical trials for newly diagnosed patients and the age-groups included herein [ 40 , 41 , 42 ]. Our analysis revealed a clear tendency of higher expression levels for our 3-miRNA signature in the high-risk group.…”