This protocol covers the management of newly diagnosed glioblastoma in a specific patient group: individuals under 65–70 years of age with good functional status whose tumors carry MGMT promoter methylation. Treatment decisions in this population depend on age, functional status, MGMT status, and patient care goals.
Given the modest benefits of standard treatments, participation in clinical trials is highly recommended for patients with good performance status of any age.
Enrollment in a clinical trial is the preferred first step when available. For patients in this group, the standard approach involves a radiotherapy-based regimen used together with concurrent and maintenance chemotherapy; a device-based adjunct may also be considered alongside chemotherapy. For patients with MGMT-methylated tumors specifically, an alternative combined chemotherapy strategy combined with radiotherapy has also demonstrated a survival benefit in this setting.
DOI: 10.1093/neuonc/noaf177
Treatment decisions for glioblastoma after maximal safe resection depend on age, functional status, MGMT status, and patient care goals (Figure 8).
Given the modest benefits of standard treatments, participation in clinical trials is highly recommended for patients with good performance status of any age.
For patients with good performance status, standard-of-care includes radiotherapy (60 Gy over 6 weeks) with concurrent temozolomide (75 mg/m2/day × 6 weeks), followed by maintenance temozolomide (150–200 mg/m2/day × 5 days for six 28-day cycles).
The addition of tumor-treating fields (TTF) to adjuvant chemotherapy may also be considered.
Another option for patients with MGMT promoter methylated tumors is lomustine-temozolomide combined with radiotherapy as per the CeTeG/NOA-09 trial, which demonstrated a survival benefit over standard of care, yet, there was no PFS benefit, and treatment options at recurrence are limited after failure on that regimen.
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