Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma

Original Article
Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma

James R. Perry, M.D., Normand Laperriere, M.D., Christopher J. O’Callaghan, D.V.M., Alba A. Brandes, M.D., Johan Menten, M.D., Claire Phillips, M.B., B.S., Michael Fay, M.B., Ch.B., Ryo Nishikawa, M.D., J. Gregory Cairncross, M.D., Wilson Roa, M.D., David Osoba, M.D., John P. Rossiter, M.B., B.Ch., Arjun Sahgal, M.D., Hal Hirte, M.D., Florence Laigle-Donadey, M.D., Enrico Franceschi, M.D., Olivier Chinot, M.D., Vassilis Golfinopoulos, M.D., Laura Fariselli, M.D., Antje Wick, M.D., Loic Feuvret, M.D., Michael Back, M.B., B.S., Michael Tills, M.B., B.S., Chad Winch, M.Sc., Brigitta G. Baumert, M.D., Wolfgang Wick, M.D., Keyue Ding, Ph.D., and Warren P. Mason, M.D., for the Trial Investigators*

N Engl J Med 2017; 376:1027-1037March 16, 2017DOI: 10.1056/NEJMoa1611977
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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. (Funded by the Canadian Cancer Society Research Institute and others; ClinicalTrials.gov number, NCT00482677.)

Supported by grants (015469 and 021039) from the Canadian Cancer Society Research Institute, by an unrestricted grant from Schering-Plough (now Merck), and by the EORTC Cancer Research Fund from Belgium.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Drs. Perry and Laperriere contributed equally to this article.

We thank the patients and their families for their participation in this research.