Glioblastoma care in the elderly. Issue 2 (30th November 2015)

• Record Type: Journal Article
• Authors: Jordan, Justin T.; Gerstner, Elizabeth R.; Batchelor, Tracy T.; Cahill, Daniel P.; Plotkin, Scott R.
• Is Part Of: Cancer. Volume 122:Issue 2(2016)
• Page Start: 189
• Page End: 197
• Publication Date: 2015-11-30
• Subjects: elderly -- glioblastoma -- neuro‐oncology -- O(6)‐methylguanine‐DNA methyltransferase (MGMT); Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.29742
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Glioblastoma is common among elderly patients, a group in which comorbidities and a poor prognosis raise important considerations when designing neuro‐oncologic care. Although the standard of care for nonelderly patients with glioblastoma includes maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide, the safety and efficacy of these modalities in elderly patients are less certain given the population's underrepresentation in many clinical trials. The authors reviewed the clinical trial literature for reports on the treatment of elderly patients with glioblastoma to provide evidence‐based guidance for practitioners. In elderly patients with glioblastoma, there is a survival advantage for those who undergo maximal safe resection, which likely includes an incremental benefit with increasing completeness of resection. Radiotherapy extends survival in selected patients, and hypofractionation appears to be more tolerable than standard fractionation. In addition, temozolomide chemotherapy is safe and extends the survival of patients with tumors that harbor O(6)‐methylguanine‐DNA methyltransferase ( MGMT ) promoter methylation. The combination of standard radiation with concurrent and adjuvant temozolomide has not been studied in this population. Although many questions remain unanswered regarding the treatment of glioblastoma in elderly patients, the available evidence provides a framework on which providers may base individual treatment decisions. The importance of tumor biomarkers is increasingly apparent in elderly patients, for whom the therapeutic efficacy of any treatment must be weighed against its potential toxicity. MGMT promoter methylation status has specifically demonstrated utility in predicting the efficacy of temozolomide and should be considered in treatment decisions when possible. Cancer 2016;122:189–197. © 2015 American Cancer Society . Abstract : Glioblastoma is most common in elderly patients, yet most clinical trials for glioblastoma exclude patients of advanced age. Understanding data specific to this important population is critical for the practicing oncologist to make informed decisions regarding care.