Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Exploring management of elderly patients with glioblastoma using data from 2 randomised trials (GEINO1401/EX-TEM) (#200)

Lucy Gately 1 2 , Carlos Mesia 3 , Juan Manuel Sepúlveda 4 , Sonya del Barco 5 , Estela Pineda 6 , Regina Gironés 7 , José Fuster 8 , Wei Hong 1 , Sanjeev Gill 2 , Luis Miguel Navarro 9 , Ana Herrero 10 , Anthony Dowling 11 , Ramón De La Peñas 12 , Maria Angeles Vaz 13 , Miriam Alonso 14 , Zarnie Lwin 15 , Rosemary Harrup 16 , Sergio Peralta 17 , Peter Gibbs 1 , Carmen Balana 18 19
  1. Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
  2. Medical Oncology, Alfred Hospital, Melbourne, Australia
  3. Medical Oncology Service , Hospitalet de Llobregat, Barcelona, Spain
  4. Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
  5. Medical Oncology Service, Institut Català d'Oncologia Girona , Girona, Spain
  6. Medical Oncology Service, Hospital Clinic de Barcelona,, Barcelona, Spain
  7. Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
  8. Medical Oncology Service, Hospital Son Espases, Palma De Mallorca, Spain
  9. Medical Oncology Service, Hospital de Salamanca, Salamanca\, Spain
  10. Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
  11. Department of Medical Oncology, St Vincent’s Hospital Melbourne, Melbourne, Australia
  12. Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
  13. Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
  14. Medical Oncology Service, Hospital Virgen del Rocio, Sevilla, Spain
  15. Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane , Australia
  16. Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia
  17. Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
  18. Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain
  19. Applied Research Group in Oncology (B-ARGO), Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP),, Badalona, Spain

Introduction: The optimal duration of post-radiation temozolomide in newly diagnosed glioblastoma remains unclear. A combined analysis of 2 randomised trials, GEINO14-01 (Spain) and EX-TEM (Australia) studies, recently demonstrated no benefit from extending post-radiation temozolomide.

Objective: Here we report a sub-group analysis of elderly patients (EP).   

Methods: EP (aged 65 years and over) were identified in the combined dataset. Relevant intergroup statistics were used to identify differences in tumour, treatment and outcome characteristics based on age.  Survival was estimated using the Kaplan Meier method.

Results: Of the combined 205 patients, 57 (28%) were EP. 95% of EP were ECOG 0-1 and 65% underwent gross total resection compared with 97% and 61% of younger patients (YP) respectively. There were numerically less MGMT methylated (56% vs 63%, p=0.4) and IDH mutated (4% vs 13%, p=-.1) tumours in EP vs YP. At diagnosis, EP were more likely to receive short course radiotherapy (17.5% vs 6%, p=0.017), however per protocol completion was similar. At recurrence, there was a trend for EP to receive non-surgical options (96.2% vs 84.6%, p=0.06) or best supportive care (28.3% vs 15.4%, p=0.09). EP were less likely to receive bevacizumab at any time during treatment (23.1% vs 49.5%, p=0.0013). Median progression free survival was similar at 9.3months in EP and 8.5months in YP, with median overall survival being 20months for both.

Conclusion: EP in these trials had similar baseline characteristics but received less aggressive therapy at diagnosis and recurrence. Despite this, survival remains similar compared to YP. Further examination into assessment of fitness in EP and utility of salvage therapies is required.