The Role of Temozolomide in Elderly Patients with Glioblastoma

Abstract

The administration of temozolomide concomitant with and adjuvant to radiotherapy was established as the standard of care for patients with newly diagnosed glioblastoma following the publication of a large randomized clinical trial conducted by the European Organization for Research and Treatment of Cancer (EORTC) and the National Cancer Institute of Canada (NCIC) [1]. However, this trial had as an eligibility criterion an upper age limit of 70 years, and thus the value of this therapy in older patients with glioblastoma could not be determined. Management of older patients with glioblastoma is an area that has been relatively neglected. In particular, prospective clinical trials in this patient population are rare, despite the fact that glioblastoma occurs most commonly in patients aged 65 to 84 years and the median age for diagnosis of a glioblastoma is between 60 and 65 years. Advancing age is recognized as a poor prognostic factor in glioblastoma, and treatment of older patients often is approached in a somewhat nihilistic fashion; however, increasingly it has been recognized that elderly oncology patients may benefit from and desire the same aggressive management given to younger patients. Recognizing the importance of these unanswered issues, Brandes et al. conducted a prospective clinical trial to examine the efficacy of concomitant and adjuvant temozolomide in elderly patients with glioblastoma; in addition, they assessed predictive markers of tumor response.