title: Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial.
abstract: OBJECTIVE
  The management of glioblastoma multiforme (GBM) in elderly patients with poor performance status is not well established. A trial evaluating the efficacy and safety of temozolomide alone in this population was undertaken.
  
  
  METHODS
  Patients age 70 years or older with newly diagnosed GBM and postoperative Karnofsky performance score (KPS) less than 70 were eligible for this nonrandomized phase II trial. Treatment consisted of 150 to 200 mg/m(2)/d temozolomide for 5 days every 4 weeks until disease progression. Radiotherapy was not administered. The primary end point was overall survival (OS); secondary end points included progression-free survival (PFS), safety, quality of life, and cognition.
  
  
  RESULTS
  Seventy patients (median age, 77 years; median KPS, 60) were enrolled between July 2007 and February 2009. Grade 3 to 4 neutropenia and thrombocytopenia occurred in 13% and 14% of patients, respectively. Median PFS was 16 weeks (95% CI, 10 to 20 weeks), and median OS was 25 weeks (95% CI, 19 to 28 weeks), comparing favorably with a 12- to 16-week OS expected from a purely supportive approach. Twenty-three patients (33%) improved their KPS by 10 or more points, and 18 (26%) became capable of self-care (KPS ≥ 70). Overall quality of life and cognition improved over time before disease progression. In the 31 tumors evaluated for O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation, a methylated status indicated longer PFS (26 v 11 weeks; P = .03) and OS (31 v 19 weeks; P = .03).
  
  
  CONCLUSIONS
  Temozolomide has an acceptable tolerance in elderly patients with GBM and KPS less than 70. It is associated with improvement of functional status in 33% of patients and appears to increase survival compared with supportive care alone, especially in patients with methylated MGMT promoter.
authors.affiliation: Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Blvd de l'Hôpital, Paris, France.
authors.forename: Jaime
authors.initials: J
authors.lastname: Gállego Pérez-Larraya
authors.forename: François
authors.initials: F
authors.lastname: Ducray
authors.forename: Olivier
authors.initials: O
authors.lastname: Chinot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Catry-Thomas
authors.forename: Luc
authors.initials: L
authors.lastname: Taillandier
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Guillamo
authors.forename: Chantal
authors.initials: C
authors.lastname: Campello
authors.forename: Annick
authors.initials: A
authors.lastname: Monjour
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Cartalat-Carel
authors.forename: Maryline
authors.initials: M
authors.lastname: Barrie
authors.forename: Aymeri
authors.initials: A
authors.lastname: Huchet
authors.forename: Patrick
authors.initials: P
authors.lastname: Beauchesne
authors.forename: Mona
authors.initials: M
authors.lastname: Matta
authors.forename: Karima
authors.initials: K
authors.lastname: Mokhtari
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Tanguy
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Delattre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D003071:Cognition; D019175:DNA Methylation / Q000187:drug effects; D015254:DNA Modification Methylases / Q000378:metabolism; D045643:DNA Repair Enzymes / Q000378:metabolism; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005602:France / Q000453:epidemiology; D005909:Glioblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D000077204:Temozolomide; D016896:Treatment Outcome; D025521:Tumor Suppressor Proteins / Q000378:metabolism
chemical_list: D018906:Antineoplastic Agents, Alkylating; D025521:Tumor Suppressor Proteins; D003606:Dacarbazine; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes; D000077204:Temozolomide