Malignant astrocytoma in elderly patients: where do we stand?
Ghazaleh Tabatabai1, Roger Stupp, Wolfgang Wick
1aDepartment of Neurology bDepartment of Medical Oncology, University Hospital Zurich, Zurich, Switzerland cDepartment of Neurooncology, National Center for Tumor Disease and Neurology Clinic, University Hospital Heidelberg, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Current Opinion in Neurology
|October 25, 2013
Summary
Elderly patients with malignant astrocytoma have poorer outcomes. Treatment strategies now focus on O-methylguanine-DNA-methyltransferase (MGMT) gene promoter methylation status, with ongoing trials exploring combined therapies.
Area of Science:
- Neuro-oncology
- Geriatric oncology
- Cancer research
Background:
- Age is a significant prognostic factor for primary brain tumors, including malignant astrocytoma.
- Elderly patients often present with fewer prognostically favorable factors compared to younger counterparts.
- Understanding age-related outcomes is crucial for optimizing treatment strategies.
Purpose of the Study:
- To review clinical outcome data for elderly patients with malignant astrocytoma.
- To discuss future research directions in this patient population.
Main Methods:
- Review of available clinical outcome data.
- Analysis of phase III clinical trials (NOA-08, Nordic trials).
- Discussion of ongoing clinical trials and translational studies.
Main Results:
- Radiotherapy with hypofractionation was a standard for patients over 65-70 years.
- Temozolomide (TMZ) monotherapy showed non-inferiority to radiotherapy.
- O-methylguanine-DNA-methyltransferase (MGMT) gene promoter methylation status predicts benefit from TMZ chemotherapy.
Conclusions:
- Current treatment for elderly malignant astrocytoma patients is guided by MGMT gene promoter methylation status.
- Ongoing trials investigate combined radiotherapy and TMZ chemotherapy, and anti-VEGF therapy.
- Poorer outcomes in the elderly may be linked to a lack of favorable prognostic factors in tumor tissue.
