Is it ever appropriate to omit temozolomide in unmethylated glioblastoma?
Do you consider the small, but statistically significant, improvement in OS to outweigh the side effects of treatment?
Answer from: Radiation Oncologist at Academic Institution
Perhaps a different perspective on this question would be which unmethylated patients would you be willing to not treat with up-front temozolomide? The genesis of the question and conundrum comes from the modest benefit described in the above-mentioned trials for this subgroup. As Hegi herself descr...
Sign in or Register to read more
Answer from: Radiation Oncologist at Community Practice
This is a good question, and of course, the answer hinges upon "why are you considering de-escalating treatment intensity for your individual patient?"The OS benefit of TMZ in the original Stupp/Hegi report showed an HR of 0.69, p value of 0.06 for unmethylated patients, with median OS 11.8 mo for R...
Answer from: at Academic Institution
I agree with the detailed reply by Dr. @Tim J. Kruser.I would add that in the Hegi NEJM 2005 article, <2% of unmethylated patients treated with RT alone survived 2 years, while 13.8% unmethylated patients treated with RT + TMZ were alive at 2 years. Although this proportion is far less than the 4...