GBL of the elderly: unsolved questions Enrico Marchioni Istituto - - PowerPoint PPT Presentation

Enrico Marchioni

Istituto Neurologico Nazionale IRCCS “C. Mondino”, Pavia

GBL of the elderly: unsolved questions

• Who’s elder?

65 or 70? functional status? comorbidity?

• Stupp protocol:
• not well tolerated in the elderly
• temozolomide:
• best choice in mMGMT+ ?
• radiotherapy?
• benefit or only morbidity?
• standard vs hypofractionated

GBL of the elderly: unsolved questions

The optimal therapeutic approach in elderly patients is of major interest as:

• approssimately half of all patients with GBL are older than 65
• the incidence of GBL in the elderly population is increasing
• many eldery individuals cannot tolerate combined therapy

Combined treatment: the EORTC-NCIC trial confirmed significant improvements in OS, but:

• these data offer little information regarding best practice for the treatment of the elderly

pts with GBL

• nly a minority of patients enrolled in EORTC-NCIC trial were older than 65 yrs and patients
• lder than 70 yrs were excluded

GBM of the elderly: the state of the knowledge

Our experience

Last 45 pts > 60 yrs:

Grade IV 5 myelosuppression 3 sepsis HSE encephalitis 2

All patients stopped definitively the treatment

unpublished published

6 out 7 GBL patients develop HSE during or few weeks after Stupp protocol and 2 over 60 died of encephalitis Should acyclovir be added to the treatment protocol other than antibiotics?

Wick et al. Lancet Oncol 2012

412 pts >65 yo KPS>60 Temodal 100 mg/m2 7 day ON/7 day OFF vs RT 60 Gy

all 60-70 yrs > 70 yrs

Stratified by MGMT promoter metylation status temozolomide combined cht+rt all groups irrespective of treatments

> 65 mMGMT+ TMZ TMZ +

• Hypofract. rt

mMGMT- Individualized to the patient

• Hypofract. rt

Thanks for attention