COT-16 INDICATION OF SYSTEMIC THERAPY FOR ELDER PATIENTS WITH BRAIN TUMORS: A SYSTEMATIC REVIEW AND PERSPECTIVE

BACKGROUND: Little is known about indications and outcome prediction of systemic therapy for elderly patients with brain tumours. Clinical conditions of individuals are heterogenous from healthy to frail or diseased,moreover,are often reversible. METHOD: We retrieved the literature of brain tumour,systemic therapy,chemotherapy,immunotherapy,in randomized controlled trials (RCTs) and reviews on PubMed database from 2008 to 2018. RESULTS: 1) Definition of elderly by age in years: Depending on each protocol,the definition is arbitrary. Patients older than 60 or 70 years are usually in the elderly group. 2) Systemic evaluation: Performance status (PS) and visceral function are not sufficient to assess elderly patients. Assessment tools specifically developed for the geriatric population are recommended to evaluate individual patients. 3) Effects and toxicity of systemic therapy: Only a few RCT showed no inferiority of outcome in patients older than 60 or 65 years. There are only few evidences about the senile fragility of blood-brain barrier or distribution of drugs in the elderly brain. Molecular subtyping of brain tumours might predict the effects and toxicities of therapies for elderly patients. CONCLUSION: Feasibility of modern systemic therapies are not well studied for elderly patients with brain tumours. Clinical condition varies in individual elderly patients. We need prospective studies of systemic therapy in elderly patients based on an eligibility with not only chronologic age but comprehensive geriatric assessments.