Temodar with Chemoradiation Improves Survival in Elderly Glioblastoma Patients

Adding temozolomide (Temodar) to chemoradiation improved survival in elderly glioblastoma patients, reducing the risk of death by 33%, in a recent study.

The international phase 3 trial enrolled 562 newly diagnosed glioblastoma patients who were 65 years and older. The median age was 73-years-old, with two-thirds of patients older than 70-years-old.

Randomized patients received either short-course radiation therapy, at 40Gy in 15 fractions over 3 weeks with concurrent and adjuvant Temodar, or radiation therapy alone.

The results of the study, presented at the American Society of Clinical Oncology Annual Meeting, showed that chemoradiation improved median overall survival from 7.6 months to 9.3 months. Furthermore, tumor growth slowed in the Temodar group with a median progression-free survival of 5.3 months versus 3.9 months.

“Although the difference in median survival seems modest, temozolomide significantly increased the chances of surviving 2 or 3 years,” said lead study co-author James R. Perry, MD, FRCPC. “For an individual patient, that can mean being able to be part of another family holiday celebration."

In the radiation plus Temodar group, the 1- and 2-year survival rates were 37.8% and 10.4%, respectively, versus 22.2% and 2.8% in radiation therapy alone.

In 165 patients with MGMT promoter methylation, there was a greater benefit of Temodar. In these patients, the median overall survival was 13.5 months with Temodar and 7.7 months with radiation therapy alone. Patients administered Temodar had a 47% lower risk of death than those who received radiation alone.

There were no differences among the 2 groups in physical, cognitive, emotional, and social functioning. Patients administered Temodar experienced more nausea, constipation, and vomiting than patients in the radiation therapy alone group.

“Although glioblastoma disproportionately affects older patients, there are no clear guidelines for treating these patients, and practice varies globally,” Perry said. “This study provides the first evidence from a randomized clinical trial that chemotherapy in combination with a shorter radiation schedule significantly extends survival without a detriment to quality of life.”