According to a new study published in the journal Annals of Oncology, researchers have found that elderly patients with primary central nervous system lymphoma (PCNSL) benefit from high dose-methotrexate (HD-MTX) based therapy, especially when combined with oral alkylating agents.
For the review, investigators sought to investigate prognosis and effects of first-line therapy in elderly patients with PCNSL. They identified 20 studies that included data from 783 patients with a median age of 68 years and a median Karnofsky Performance Score of 60%. Researchers found that 73% of patients were treated with HD-MTX-based therapy and 35% received whole brain radiotherapy.
Results showed that a Karnofsky Performance Score ≥70% was the strongest prognostic factor for mortality (HR = 0.50; 95% CI: 0.41 – 0.62). Researchers found that after a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR = 0.70; 95% CI: 0.53 – 0.93).
Researchers found no difference between more aggressive HD-MTX based therapies and HD-MTX plus oral chemotherapy (HR = 1.39; 95% CI: 0.90 – 2.15). In addition, despite being associated with improved survival, radiation therapy was linked with an elevated risk for neurological adverse events (OR = 5.23; 95% CI: 2.33 – 11.74).
The findings suggest that elderly patients with PCNSL benefit from HD-MTX-based therapy, particularly when used in combination with oral alkylating agents.