Abstract
OBJECTIVE: We report the functional status and steroid dosing changes in a phase II clinical trial of bevacizumab and temozolomide for upfront treatment of patients with GBM and age ≥70. Evaluation of steroid use and functional status changes are important aspects of determining treatment success in improving or maintaining quality of life for patients with GBM. METHODS: 50 GBM patients with age ≥70, KPS ≥60, were enrolled in this trial. Patients received treatments 4–6 weeks after surgery with bevacizumab and temozolomide until tumor progression. The maximal change in Karnofsky Performance Status (KPS) and dexamethasone dose from the start of treatment to date of progression is evaluated. RESULTS: Of the 46 patients with KPS data, the median KPS was 80 at the start of treatment. 27 (58.7%) patients had stable KPS throughout the study, with a median KPS of 80. 11 (23.9%) had KPS improvement, with a median score of 90. 8 patients (17.4%) had a decline in KPS, 6 of which were stable throughout treatment and presented a lower KPS only at disease progression. The median KPS score was 65 for these 8 patients. Of the 45 patients with dexamethasone data, 15 (33.3%) patients were not on dexamethasone at any point during treatment. 18 (60% of those on dexamethasone) were able to come off steroids completely by the end of their treatment. 12 (40%) patients remained on dexamethasone throughout the study, but 5 patients were able to reduce dosages, all by half or more. 2 patients who remained on steroids had to increase dexamethasone dose, one from 8mg total daily dosing to 12mg daily, and the other patient 2mg daily to 8mg daily. CONCLUSION: Our data suggests that upfront treatment with temozolomide and bevacizumab for elderly GBM patients can positively impact quality of life.