No Clinically Relevant Differences in QOL and Neurocognitive Function with Lomustine/Temozolomide for Glioblastoma

In the phase III CeTeG/NOA-09 trial, researchers led by Weller et al. investigated the effects of lomustine/temozolomide versus temozolomide alone on health-related quality of life (HRQOL) and neurocognitive function in patients with newly diagnosed MGMT-methylated glioblastoma. The study, published in The Lancet Oncology, involved 129 patients who were randomly assigned to receive either lomustine/temozolomide or temozolomide alone, alongside standard radiotherapy.

Study Details:

• Patients received six 6-week courses of oral lomustine plus temozolomide or standard oral temozolomide plus six 4-week courses of temozolomide.
• Assessments included HRQOL using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire Core-30, and neurocognitive function using the Mini Mental State Examination (MMSE) and a neurocognitive test battery.

Key Findings:

• No significant impairment in HRQOL was observed in the lomustine/temozolomide group.
• A significant but not clinically relevant difference favoring temozolomide alone was found for MMSE.
• No significant differences were found between the two groups in any subtest of the neurocognitive test battery.

Conclusion: The absence of systematic and clinically relevant changes in HRQOL and neurocognitive function, combined with the survival benefit of lomustine/temozolomide versus temozolomide alone, suggests a long-term net clinical benefit for patients with newly diagnosed glioblastoma with methylation of the MGMT promoter. This supports the use of lomustine/temozolomide as a treatment option for these patients.

Ulrich Herrlinger, MD, of the Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, is the corresponding author of The Lancet Oncology article.