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Gately L, Mesía C, Sepúlveda JM, Del Barco S, Pineda E, Gironés R, Fuster J, Dumas M, Gill S, Navarro LM, Herrero A, Dowling A, de Las Peñas R, Vaz MA, Alonso M, Lwin Z, Harrup R, Peralta S, Long A, Perez-Segura P, Ahern E, Garate CO, Wong M, Campbell R, Cuff K, Jennens R, Gallego O, Underhill C, Martinez-Garcia M, Covela M, Cooper A, Brown S, Rosenthal M, Torres J, Collins IM, Gibbs P, Balana C. Exploring management and outcomes of elderly patients with glioblastoma using data from two randomised trials (GEINO1401/EX-TEM). J Neurooncol 2024; 168:299-306. [PMID: 38630385 DOI: 10.1007/s11060-024-04668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE The impact of age on optimal management of glioblastoma remains unclear. A recent combined analysis of two randomised trials, GEINO14-01 and EX-TEM, found no benefit from extending post-radiation temozolomide in newly diagnosed glioblastoma. Here, we explore the impact of age. METHODS Relevant intergroup statistics were used to identify differences in tumour, treatment and outcome characteristics based on age with elderly patients (EP) defined as age 65 years and over. Survival was estimated using the Kaplan Meier method. RESULTS Of the combined 205 patients, 57 (28%) were EP. Of these, 95% were ECOG 0-1 and 65% underwent macroscopic 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 = 0.1) tumours in EP vs. YP. Following surgery, EP were more likely to receive short course chemoradiation (17.5% vs. 6%, p = 0.017). At recurrence, EP tended to receive or best supportive care (28.3% vs. 15.4%, p = 0.09) or non-surgical options (96.2% vs. 84.6%, p = 0.06), but were less likely to receive bevacizumab (23.1% vs. 49.5%, p < 0.01). Median PFS was similar at 9.3months in EP and 8.5months in YP, with similar median OS at 20months. CONCLUSION In this trial population of predominantly fit EP, survival was similar to YP despite a proportion receiving less aggressive therapy at diagnosis and recurrence. Advancing age does not appear to be an adverse prognostic factor for glioblastoma when patients are fit for treatment, and a less aggressive approach in selected patients may not compromise outcomes.
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Affiliation(s)
- Lucy Gately
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
- Department of Medical Oncology, Alfred Health, Prahran, VIC, Australia.
| | - C Mesía
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain
| | - J M Sepúlveda
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Del Barco
- Medical Oncology Service, Institut Català d'Oncologia Girona, Girona, Spain
| | - E Pineda
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - R Gironés
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - J Fuster
- Medical Oncology Service, Hospital Son Espases, Palma De Mallorca, Spain
| | - M Dumas
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - S Gill
- Department of Medical Oncology, Alfred Health, Prahran, VIC, Australia
| | - L M Navarro
- Medical Oncology Service, Hospital de Salamanca, Salamanca, Spain
| | - A Herrero
- Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
| | - A Dowling
- Department of Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - R de Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Vaz
- Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - M Alonso
- Medical Oncology Service, Hospital Virgen del Rocio, Sevilla, Spain
| | - Z Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - R Harrup
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - S Peralta
- Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
| | - A Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - P Perez-Segura
- Medical Oncology Service, Hospital Clinico San Carlos, Madrid, Spain
| | - E Ahern
- Department of Medical Oncology, Monash Health, Bentleigh, VIC, Australia
| | - C O Garate
- Medical Oncology Service, Hospital Universitario Fundación Alcorocón, Alcorcón, Spain
| | - M Wong
- Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - R Campbell
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - K Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, Insert City, VIC, Australia
| | - O Gallego
- Medical Oncology Service, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - C Underhill
- Department of Medical Oncology, Border Medical Oncology Research Unit, East Albury, NSW, Australia
- University of New South Wales Rural Medical School, Albury Campus, Albury, NSW, Australia
| | | | - M Covela
- Medical Oncology Service, Hospital Lucus Augusti, Lugo, Spain
| | - A Cooper
- Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Brown
- Department of Medical Oncology, Ballarat Health Services, Ballarat, VIC, Australia
| | - M Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Torres
- Department of Medical Oncology, Goulburn Valley Health, Melbourne, VIC, Australia
| | - I M Collins
- Department of Medical Oncology, South West Regional Cancer Centre, Warrnambool, VIC, Australia
| | - P Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - C Balana
- Medical Oncology Service, Institut Català d'Oncologia Girona, Badalona, Spain
- Applied Research Group in Oncology (B-ARGO) from the Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
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Gupta T, Selvarajan JMP, Kannan S, Menon N, Dasgupta A, Chatterjee A. Updated systematic review and meta-analysis of extended adjuvant temozolomide in patients with newly diagnosed glioblastoma. Neurooncol Adv 2023; 5:vdad086. [PMID: 37638346 PMCID: PMC10457033 DOI: 10.1093/noajnl/vdad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Background Contemporary standard-of-care for newly diagnosed glioblastoma (GBM) is maximal safe resection followed by postoperative focal conformal radiotherapy (RT) plus concurrent temozolomide (TMZ) and 6-cycles of adjuvant TMZ (Stupp regimen). However, many patients continue to receive extended adjuvant TMZ (beyond 6-cycles) without solid scientific evidence. This review pools data from nonrandomized studies and randomized controlled trials (RCTs) comparing extended adjuvant TMZ (>6-cycles) to standard adjuvant TMZ (6-cycles) in patients with newly diagnosed GBM for updated evidence-synthesis. Methods This systematic review and meta-analysis was carried out in accordance with the Cochrane methodology including quality assessment of primary studies. Primary outcome of interest was comparative efficacy defined as progression-free survival (PFS) and overall survival (OS). Hazard ratios (HRs) for PFS and OS with corresponding 95% confidence interval (CIs) were extracted/computed from individual primary studies and pooled using random-effects model. Any p-value <0.05 was considered statistically significant. Results Evidence-synthesis was based on pooling of data from 2578 patients enrolled in 16 nonrandomized comparative studies and 5 RCTs. Overall, extended adjuvant TMZ was associated with statistically significant reduction in the risk of progression (HR = 0.72, 95%CI: 0.60-0.87; p = 0.007) and death (HR = 0.71, 95%CI: 0.57-0.90; p = 0.004) compared to standard adjuvant TMZ. However, on subgroup analysis, survival benefit of extended adjuvant TMZ was limited to data synthesized from retrospective nonrandomized comparative studies with no statistically significant difference in outcomes seen after pooling of data from RCTs only. Conclusion Apparent survival benefit of extended adjuvant TMZ in newly diagnosed GBM is largely driven by nonrandomized comparative studies with high inherent potential for multiple biases.
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Affiliation(s)
- Tejpal Gupta
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Sadhana Kannan
- Department of Clinical Research Secretariat, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Archya Dasgupta
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Lee B, Gately L, Lok SW, Tran B, Lee M, Wong R, Markman B, Dunn K, Wong V, Loft M, Jalili A, Anton A, To R, Andrews M, Gibbs P. Leveraging Comprehensive Cancer Registry Data to Enable a Broad Range of Research, Audit and Patient Support Activities. Cancers (Basel) 2022; 14:cancers14174131. [PMID: 36077668 PMCID: PMC9454529 DOI: 10.3390/cancers14174131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Registry data has the potential to support a broad range of research, audit and education initiatives. Here, we describe the experience and learnings of a series of large multi-institutional cancer registries that leverage real-world clinical data for a range of purposes, that informs the conduct and output of each registry in a virtuous cycle. Lessons learnt include the need for careful and continuous curation of information being collected, regular database updates, and the need for a continued focus on data quality. As a standalone resource, each registry has supported numerous projects, but linkage with external datasets with patients in common has enhanced the research potential. Multiple projects have linked registry data with matched tissue specimens to support the discovery and valiation of prognostic and predictive markers in the tumour and blood specimens. Registry-based biomarker trials have been successfully supported, generating novel and practice-changing data. Registry-based clinical trials, particularly studies exploring the best use of drug options are now complementing the research conducted in traditional clinical trials. More recent projects supported by the registries include health economic studies, personalised patient education material, and increased consumer engagement, including consumer entered data. Abstract Traditional cancer registries have often been siloed efforts, established by single groups with limited objectives. There is the potential for registry data to support a broad range of research, audit and education initiatives. Here, we describe the establishment of a series of comprehensive cancer registries across the spectrum of common solid cancers. The experience and learnings of each registry team as they develop, implement and then use collected data for a range of purposes, that informs the conduct and output of other registries in a virtuous cycle. Each registry is multi-site, multi-disciplinary and aims to collect data of maximal interest and value to a broad range of enquiry, which would be accessible to any researcher with a high-quality proposal. Lessons learnt include the need for careful and continuous curation of data fields, with regular database updates, and the need for a continued focus on data quality. The registry data as a standalone resource has supported numerous projects, but linkage with external datasets with patients in common has enhanced the audit and research potential. Multiple projects have linked registry data with matched tissue specimens to support prognostic and predictive biomarker studies, both validation and discovery. Registry-based biomarker trials have been successfully supported, generating novel and practice-changing data. Registry-based clinical trials, particularly randomised studies exploring the optimal use of available therapy options are now complementing the research conducted in traditional clinical trials. More recent projects supported by the registries include health economic studies, personalised patient education material, and increased consumer engagement, including consumer entered data.
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Affiliation(s)
- Belinda Lee
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Northern Health, Epping, VIC 3076, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- School of Medicine and Dentistry, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence:
| | - Lucy Gately
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Cabrini Haematology and Oncology Centre, Malvern, VIC 3144, Australia
| | - Sheau Wen Lok
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Ben Tran
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Margaret Lee
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3151, Australia
- Department of Medical Oncology, Western Hospital, Melbourne, VIC 3021, Australia
| | - Rachel Wong
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3151, Australia
- Eastern Health Clinical School, Monash University, Clayton, VIC 3800, Australia
| | - Ben Markman
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Kate Dunn
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Vanessa Wong
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Ballarat Health Service, Ballarat Central, VIC 3350, Australia
| | - Matthew Loft
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Azim Jalili
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Northern Health, Epping, VIC 3076, Australia
- Department of Medical Oncology, Western Hospital, Melbourne, VIC 3021, Australia
| | - Angelyn Anton
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3151, Australia
| | - Richard To
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- School of Medicine and Dentistry, University of Melbourne, Parkville, VIC 3010, Australia
| | - Miles Andrews
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Peter Gibbs
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- School of Medicine and Dentistry, University of Melbourne, Parkville, VIC 3010, Australia
- Department of Medical Oncology, Western Hospital, Melbourne, VIC 3021, Australia
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