425P - The role of temozolomide and radiation therapy in elderly patients with glioblastoma: A monoinstitutional retrospective study

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Geriatric Oncology
Central Nervous System Malignancies
Surgery and/or Radiotherapy of Cancer
Presenter Patrizia Farina
Citation Annals of Oncology (2014) 25 (suppl_4): iv137-iv145. 10.1093/annonc/mdu330
Authors P. Farina1, G. Lombardi1, L. Bellu2, P. Fiduccia3, F. Berti4, F. Navarria5, A. Della Puppa6, V. Zagonel1
  • 1Medical Oncology 1 Unit, Veneto Institute of Oncology, 35128 - Padua/IT
  • 2Medical Oncology 1, Veneto Institute of Oncology, 35128 - Padua/IT
  • 32clinical Trials And Biostatistics Unit, Veneto Institute of Oncology, 35128 - Padua/IT
  • 4Radiation Therapy Unit, Veneto Institute of Oncology, 35121 - Padova/IT
  • 5Radiation Therapy Unit, Veneto Institute of Oncology, 35121 - Padua/IT
  • 6Neurosurgery Department, Azienda Ospedaliera di Padova, 35128 - Padua/IT

Abstract

Aim

The efficacy of temozolomide(TMZ) plus radiation therapy(RT) in elderly patients(EP) with glioblastoma(GBM) is unclear. We describe our experience of combining RT with concurrent TMZ in EP.

Methods

Medical records of patients ≥65 years old with newly GBM, histologically confirmed and treated at Venetian Institute of Oncology – Padua, were reviewed. Concomitant TMZ was 75mg/m2/die. The adjuvant treatment consisted of TMZ 150-200mg/m2/die for six cycles.

Results

We analyzed 67 consecutive patients(PTS), 35 males and 32 females; the average age was 71 (range 65-86); ECOG PS was 0-1 in 37 PTS and 2-3 in 30 PTS; complete surgery was performed in 41 PTS, partial surgery in 24 PTS. MGMT was analyzed in 46 PTS: methylated(met) MGMT in 21 PTS (46%). 36 PTS were treated with RT 40Gy in 15 fractions, 23 PTS with RT 60Gy in 30 fractions, 8 PTS with only TMZ. For all PTS, PFS and OS was 7 and 12.4 ms, respectively. PFS was 7.2 vs 6.7 ms (p = 0.5), OS was 11.9 vs 13.8 ms (p = 0.3), for PTS treated with RT 40Gy and 60Gy, respectively. PFS was 7.2 vs 4.5 ms (p = 0.04), OS was 13 vs 7.3 ms (p < 0.01), for PTS treated with RT + TMZ vs only TMZ, respectively. Among PTS treated with RT + TMZ, 46 were evaluable for MGMT: 21 with metMGMT. OS was 11.7 vs 18.6 (p < 0.01) for unmet and met MGMT, respectively. We had no significant difference in terms of PFS and OS between partial and complete surgery. On multivariate analysis, RT + TMZ treatment (HR 0.2, 95% CI 95% 0.09-0.6) and metMGMT (HR 0.35, 95% CI 0.1-0.7) were independent predictors of longer OS. Regarding toxicity: grade 1-2 haematological toxicity was 19%, 23% and 42%, grade 1-2 asthenia was 25%, 23% and 42% of PTS receiving RT 40Gy + TMZ, RT 60Gy + TMZ and TMZ alone, respectively; nausea/vomiting was 5% and 3% of PTS receiving RT 60 and 40Gy; grade 3-4 haematological toxicity was 6% in PTS receiving RT + TMZ, no severe haematological toxicity and asthenia was reported in PTS receiving TMZ alone.

Conclusions

RT plus TMZ is effective and safe in EP with GBM. RT + TMZ treatment seems more effective than only TMZ. PFS and OS were not statistically different between RT 40Gy or 60Gy. RT + TMZ treatment and met MGMT were independent predictors of longer survival. In contrast, severe haematological toxicity was higher in PTS with RT + TMZ compared to TMZ alone.

Disclosure

All authors have declared no conflicts of interest.