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• W4229867898 abstract "I read with interest the article by Chinot et al. who reported a Phase II study evaluating temozolomide in 29 patients age > 70 years who were diagnosed with glioblastoma multiforme.1 Although interesting overall survival durations of 13.3 months were obtained in the group of patients who achieved a partial response, this study raises certain issues that are frequently encountered in patients with this complex tumor. The first point is the inevitable selection of patients accrued in Phase II studies. Only half of the referred patients were enrolled in the study and the minimal admitted greatest tumor dimension was 2 cm. Exclusion criteria included psychologic, familial, sociologic, or geographic conditions, which frequently are encountered in the elderly but most likely are more easily managed in the setting of a university center. These criteria demonstrate that observation remains a major concern in patients receiving oral therapies. The evaluation of response remains particularly difficult in patients with brain tumors and ideally requires external and independent review. Interpretation of the results of the study was complicated by confusing factors. A notable fraction of the patients (22%) had undergone surgery and 12% had received second-line therapy with nitrosourea. The overall survival in those patients who underwent surgery was 8.8 months, compared with an overall survival of 6.3 months in the patients who underwent biopsy only. Only baseline tumor size was found to be a prognostic factor. The role of corticosteroids also is a major concern because these can decrease the overall tumor volume significantly. The decrease in steroid dosage reported in the study by Chinot et al. is difficult to interpret because it may depend on the initial dosage, especially unusually high dosages, but also on the rate and rhythm of the dosing decrease. For example, a decrease from 500 mg of methylprednisolone to 300 mg daily is of little significance. WHO Grade 3/4 nausea, which was reported to occur in 9% of the patients, is not negligible and might limit the administration of methylprednisolone to those patients with a certain tumor volume. Because of the poor prognosis of the tumor and also because chemotherapy does not appear to be of benefit to a majority of patients, Grade 3/4 toxicities should be avoided. Platelet transfusions and granulocyte– colony-stimulating factor each were necessary in 6% of the patients in the study. It must be taken into account that the follow-up of the patients in the study by Chinot et al. was optimal, although serious consequences might have occurred within another context. The impact of temozolomide remains unclear and two fundamental questions need to be addressed. 1) Does temozolomide allow for chemotherapy to be administered in a larger proportion of patients; and 2) what are the respective impacts of chemotherapy and surgery on patient prognosis? Carol Alliot M.D.*, * Hematology/ncology Division, General Hospital of Annemasse, Annemasse, France." @default.
• W4229867898 created "2022-05-11" @default.
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• W4229867898 date "2004-01-01" @default.
• W4229867898 modified "2023-09-25" @default.
• W4229867898 title "Phase II study of temozolomide without radiotherapy in newly diagnosed glioblastoma multiforme in an elderly population" @default.
• W4229867898 cites W2017305699 @default.
• W4229867898 doi "https://doi.org/10.1002/cncr.20707" @default.
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