Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China.
Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China.
Pharmacol Res. 2022 Aug;182:106316. doi: 10.1016/j.phrs.2022.106316. Epub 2022 Jun 17.
Optimal management strategies for elderly glioblastoma (GBM) patients remain elusive. Overall survival (OS) and progression-free survival (PFS) in elderly newly diagnosed GBM (ndGBM) patients were analyzed with random-effects Bayesian network meta-analysis with the estimated hazard ratio (HR) with a 95% confidence interval (95% CrI). In addition, OS, PFS and adverse event (AE) data on ndGBM and recurrent GBM (rGBM) were assessed. Seventeen eligible trials with 12 on ndGBM and 5 on rGBM were identified. For the improvements it induced in the OS of elderly ndGBM patients, tumor treating field (TTF) + temozolomide (TMZ) (HR: 0.11, 95% CrI: 0.02-0.67 vs. supportive care (SPC)) ranked first, followed by TMZ + hyperfractionated radiotherapy (HFRT) (HR: 0.17, 95% CrI: 0.03-0.95 vs. SPC). For the improvements it induced in the PFS of elderly ndGBM patients, bevacizumab (BEV) + HFRT ranked first, followed by TMZ + HFRT. TMZ was observed to be more effective in O6-methylguanine-DNA-methyltransferase (MGMT) promoter-methylated ndGBM patients than HFRT and standard radiotherapy (STRT). For elderly rGBM patients, the treatments included were comparable. The rates of other neurological symptoms (16.1%) and lymphocytopenia (10.4%) were higher in ndGBM patients; lymphocytopenia (10.3%) and infection (8.1%) were higher in rGBM patients among the ≥ 3 grade AEs. TMZ-related AEs should be further considered. In conclusion, TTF + adjuvant TMZ and TMZ + HFRT are most likely to be recommended for elderly ndGBM patients. No best treatment for rGBM in elderly patients is illustrated. TMZ is identified to be more effective in elderly ndGBM patients with methylated MGMT status; however, AEs associated with TMZ-related therapy should be well considered and managed.
对于老年胶质母细胞瘤（GBM）患者，最佳的管理策略仍难以确定。使用随机效应贝叶斯网络荟萃分析对老年新发 GBM（ndGBM）患者的总生存期（OS）和无进展生存期（PFS）进行了分析，使用估计的风险比（HR）及其 95%置信区间（95%CrI）。此外，还评估了 ndGBM 和复发性 GBM（rGBM）的 OS、PFS 和不良事件（AE）数据。确定了 17 项符合条件的试验，其中 12 项为 ndGBM，5 项为 rGBM。在改善老年 ndGBM 患者 OS 方面，肿瘤治疗电场（TTF）+替莫唑胺（TMZ）（HR：0.11，95%CrI：0.02-0.67 vs. 支持性护理（SPC））排名第一，其次是 TMZ+超分割放疗（HFRT）（HR：0.17，95%CrI：0.03-0.95 vs. SPC）。在改善老年 ndGBM 患者 PFS 方面，贝伐单抗（BEV）+HFRT 排名第一，其次是 TMZ+HFRT。TMZ 在 O6-甲基鸟嘌呤-DNA-甲基转移酶（MGMT）启动子甲基化的 ndGBM 患者中比 HFRT 和标准放疗（STR）更有效。对于老年 rGBM 患者，治疗方法相似。ndGBM 患者中更常见的其他神经系统症状（16.1%）和淋巴细胞减少症（10.4%）；rGBM 患者中更常见的是淋巴细胞减少症（10.3%）和感染（8.1%）。≥3 级 AEs。应进一步考虑 TMZ 相关 AEs。总之，TTF+辅助 TMZ 和 TMZ+HFRT 最有可能被推荐用于老年 ndGBM 患者。老年 rGBM 患者没有最佳治疗方法。在甲基化 MGMT 状态的老年 ndGBM 患者中，TMZ 被证明更有效；然而，应充分考虑并管理与 TMZ 相关治疗相关的 AE。
