Clinical Scenario

This protocol covers newly diagnosed glioblastoma in patients younger than 65–70 years who present with poor functional status and confirmed MGMT promoter methylation — a specific subgroup requiring individualised treatment planning after maximal safe resection.

Age < 65–70 years Poor functional status MGMT promoter methylated Newly diagnosed

What Drives Treatment Selection

Treatment decisions after maximal safe resection depend on age, functional status, MGMT promoter methylation status, and individual care goals. In patients under 65–70 years, poor functional reserve and MGMT methylation together define a distinct decision pathway that differs from the standard approach used in patients with good performance status.

Treatment Approach (Partial Overview)

Where criteria are met, enrolment in a clinical trial is the preferred first consideration. When trials are not available, the approach involves radiotherapy-based strategies — including adapted schedules suited to reduced functional reserve — alongside systemic therapy. MGMT methylation status is a key factor in determining which systemic option applies.

The complete regimen options, sequencing, and eligibility criteria are in the full structured protocol.

References

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).
Treatment regimens for newly diagnosed glioblastoma patients older than 65–70 years involve standard radiochemotherapy but shortened regimens for frailer patients may include hypofractionated radiation (eg, 40 Gy in 15 fractions) with temozolomide, hypofractionated radiation alone for patients with MGMT unmethylated glioblastoma, or temozolomide alone for patients with MGMT methylated glioblastoma.

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First-Line Treatment of Glioblastoma in Patients Under 65–70 Years with Poor Functional Status and MGMT Promoter Methylation

References