Have you heard the saying that 40 is the new 30, or even that 70 is the new 60? Well, it’s not just a saying anymore; there is increasing evidence to back up this idea. People are living longer, and your age may not necessarily reflect your physical health or how you feel. However, therapies, including surgery, often have age limits, and this has long been the case for the treatment of glioblastoma multiforme (GBM). The diagnosis of GBM represents a group of fast-growing, complex brain tumors that are cancerous and can spread into healthy parts of the brain or spinal cord. Traditionally, many surgeons chose not to do surgery on older patients with GBM because of their age, and for a long time research supported this.
Though clinical trials of GBM have historically focused on younger patients, that is changing. Dr. E. Sander Connolly, renowned neurosurgeon and director of the Cerebrovascular Laboratory at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, is helping to lead this change. He recently co-authored an article in response to new research showing the benefits of chemotherapy in the treatment of elderly patients with GBM. Dr. Connolly’s article serves as a status update about the evolving research and treatment of GBM, with a focus on the elderly. The absence of the elderly in clinical trials has largely been due to the presumptions that with aging comes worsening health and decreased tolerance to treatments.
What this means is that there is a gap in medical research for GBM treatment because clinical studies have not actually focused on people who more commonly have GBM in the first place (older patients). In a previous post, Columbia Doctors Present New Glioblastoma Research, this notion was dispelled. The doctors found that in a certain group of elderly patients, surgery was not riskier than it would have been for younger patients and could be tolerated to treat a recurrence of the cancer. This point about recurrence is important, since GBM includes difficult-to-remove cells called infiltrative cells, which can spread into healthy tissue and cause the cancer to return.
In their article, Dr. Connolly and his colleagues mentioned that the standard treatment for GBM is surgery followed by radiation and chemotherapy. During surgery, as much of the tumor as possible is removed, with a goal of carefully protecting healthy brain tissue that controls important neurologic functions. Now, the authors point out, we know that this removal can be performed even in elderly patients, with good results. However, because studies have not typically included patients over 70, there has been a gap in the evidence to support the use of chemotherapy (such as temozolomide, or TMZ) and radiation for elderly patients—that is, until this new research that prompted Dr. Connolly’s response article.
The new research showed that the best (non-surgical) treatment for older patients was a combination of short-term radiation and chemotherapy. In this study, older patients actually did better than younger ones with this treatment. Further, the researchers found that elderly patients with a specific gene (called methylated MGMT) benefited more from the combination treatment than from radiation alone.
This latest status update indicates that older age alone should not be used to automatically limit treatment options for GBM. It turns out that when it comes to GBM, age really is just a number. Thankfully the surgeons here at Columbia Neurosurgery know this, and now others will too.
Learn more about Dr. Connolly on his bio page here.
McCarthy DJ, Komotar RJ, Starke RM, Connolly ES. (2017). Randomized trial for short-term radiation therapy with temozolomide in elderly patients with glioblastoma. Neurosurgery, 81(3), N21-N23.
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