Title: Temozolomide as a monotherapy for treatment of Glioblastoma Multiforme in elderly patients with poor performance status
Authors: Dr Amit Kichloo, Dr Rajan Yadav, Dr Sakina Mankada, Dr U.Surayanarayan
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.96
Abstract
Introduction
Glioblastoma is the most aggressive and most common primary malignant brain tumor in elderly population. The median age of presentation is sixty four years. The frequency in age group of more than seventy years has increased over past decade and it is rising in developed countries. Age is the most important independent prognostic factor.
The standard treatment regimen for non elderly patients is maximal safe resection followed by six weeks of concurrent involved field radiotherapy with temozolomide followed by six month of adjuvant temozolomide. This chemo radiation regimen was first published as a prospective randomized trial by STUPP et al in 2005. The trial concluded an improvement in median overall survival of 2. 5 months over radiation alone but patients more than 70 years were excluded from the study & thus the treatment in this subgroup was less clear. Moreover the tolerability of combined temozolomide and radiation seems to be reduced in the elderly population but temozolomide alone has shown promising results. RT (Radiation Treatment) alone seems to be less effective in prolonging survival. the two major reasons may be either less effectivness against the tumor or more toxic to elderly patients because of limited cerebral reserve and more risk of cognitive side effect from cranial irradiation. Elderly patients are also more susceptible to RT induced leukoencephalopathy, brain atrophy and ultimately dementia due to presence of pre existing vascular changes.
In contrast to radiation, temozolomide can be started quickly after diagnosis even from a local hospital. Moreover outpatient treatment and shorter treatment duration could lessen the burden on medical resources and reduce the risk of treatment being withheld.
Due to under representation of elderly patients with glioblastoma in clinical trials , there is a unsatisfactory data for treatment and they may be routinely undertreated to avoid toxicity given uncertain therapeutic efficacy from standard therapy .Thus we reviewed current literature on treatment of elderly patients with glioblastoma and emphasize the importance of temozolomide as a monotherapy in this population group.
