Short-course radiation plus temozolomide in elderly patients with glioblastoma

Perry, James R., Laperriere, Normand, O'Callaghan, Christopher J., Brandes, Alba A., Menten, Johan, Phillips, Claire, Fay, Michael, Nishikawa, Ryo, Cairncross, J. Gregory, Roa, Wilson, Osoba, David, Rossiter, John P., Sahgal, Arjun, Hirte, Hal, Laigle-Donadey, Florence, Franceschi, Enrico, Chinot, Olivier, Golfinopoulos, Vassilis, Fariselli, Laura, Wick, Antje, Feuvret, Loic, Back, Michael, Tills, Michael, Winch, Chad, Baumert, Brigitta G., Wick, Wolfgang, Ding, Keyue and Mason, Warren P. (2017) Short-course radiation plus temozolomide in elderly patients with glioblastoma. New England Journal of Medicine, 376 11: 1027-1037. doi:10.1056/NEJMoa1611977

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Author Perry, James R.
Laperriere, Normand
O'Callaghan, Christopher J.
Brandes, Alba A.
Menten, Johan
Phillips, Claire
Fay, Michael
Nishikawa, Ryo
Cairncross, J. Gregory
Roa, Wilson
Osoba, David
Rossiter, John P.
Sahgal, Arjun
Hirte, Hal
Laigle-Donadey, Florence
Franceschi, Enrico
Chinot, Olivier
Golfinopoulos, Vassilis
Fariselli, Laura
Wick, Antje
Feuvret, Loic
Back, Michael
Tills, Michael
Winch, Chad
Baumert, Brigitta G.
Wick, Wolfgang
Ding, Keyue
Mason, Warren P.
Title Short-course radiation plus temozolomide in elderly patients with glioblastoma
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 0028-4793
Publication date 2017-03-01
Sub-type Article (original research)
DOI 10.1056/NEJMoa1611977
Open Access Status File (Publisher version)
Volume 376
Issue 11
Start page 1027
End page 1037
Total pages 11
Place of publication Waltham, MA, United States
Publisher Massachusetts Medical Society
Collection year 2018
Language eng
Formatted abstract
Background: Glioblastoma is associated with a poor prognosis in the elderly. Survival has been shown to increase among patients 70 years of age or younger when temozolomide chemotherapy is added to standard radiotherapy (60 Gy over a period of 6 weeks). In elderly patients, more convenient shorter courses of radiotherapy are commonly used, but the benefit of adding temozolomide to a shorter course of radiotherapy is unknown.

Methods: We conducted a trial involving patients 65 years of age or older with newly diagnosed glioblastoma. Patients were randomly assigned to receive either radiotherapy alone (40 Gy in 15 fractions) or radiotherapy with concomitant and adjuvant temozolomide.

Results: A total of 562 patients underwent randomization, 281 to each group. The median age was 73 years (range, 65 to 90). The median overall survival was longer with radiotherapy plus temozolomide than with radiotherapy alone (9.3 months vs. 7.6 months; hazard ratio for death, 0.67; 95% confidence interval [CI], 0.56 to 0.80; P<0.001), as was the median progression-free survival (5.3 months vs. 3.9 months; hazard ratio for disease progression or death, 0.50; 95% CI, 0.41 to 0.60; P<0.001). Among 165 patients with methylated O6-methylguanine-DNA methyltransferase (MGMT) status, the median overall survival was 13.5 months with radiotherapy plus temozolomide and 7.7 months with radiotherapy alone (hazard ratio for death, 0.53; 95% CI, 0.38 to 0.73; P<0.001). Among 189 patients with unmethylated MGMT status, the median overall survival was 10.0 months with radiotherapy plus temozolomide and 7.9 months with radiotherapy alone (hazard ratio for death, 0.75; 95% CI, 0.56 to 1.01; P = 0.055; P = 0.08 for interaction). Quality of life was similar in the two trial groups.

Conclusions: In elderly patients with glioblastoma, the addition of temozolomide to short-course radiotherapy resulted in longer survival than short-course radiotherapy alone.
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Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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