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

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GBL of the elderly: unsolved questions Enrico Marchioni Istituto Neurologico Nazionale IRCCS C. Mondino , Pavia GBL of the elderly: unsolved questions Whos elder? 65 or 70? functional status? comorbidity? Stupp protocol:

  1. GBL of the elderly: unsolved questions Enrico Marchioni Istituto Neurologico Nazionale IRCCS “ C. Mondino ”, Pavia

  2. 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

  3. GBM of the elderly: the state of the knowledge 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 - only a minority of patients enrolled in EORTC-NCIC trial were older than 65 yrs and patients older than 70 yrs were excluded

  5. Our experience Last 45 pts > 60 yrs: Grade IV 5 myelosuppression unpublished 3 sepsis HSE encephalitis 2 published All patients stopped definitively the treatment

  6. 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?

  7. 412 pts >65 yo KPS>60 Temodal 100 mg/m2 7 day ON/7 day OFF vs RT 60 Gy Wick et al. Lancet Oncol 2012

  8. > 70 yrs all 60-70 yrs

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

  10. > 65 mMGMT+ mMGMT- TMZ TMZ + Hypofract. rt Hypofract. rt Individualized to the patient

  11. Thanks for attention

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