Characteristics, Patterns of Care and Predictive Geriatric Factors in Elderly Patients Treated for High-Grade IDH-Mutant Gliomas: A French POLA Network Study

SIMPLE SUMMARY: Gliomas remain the most common primary brain tumor in adults. Although they are classified based on the IDH mutation status very little is known considering this alteration in the elderly glioma population. Because IDH-mutated gliomas are associated with better prognosis in the young population, it is essential to characterize its role in elderly and more frail patients to help physicians’ therapeutic decisions. In this study, we demonstrated that elderly IDH-mutated gliomas had very similar characteristics to those found in the younger population but were significantly different from elderly IDH wild-type gliomas. However, patient management in this population appeared to be suboptimal, with less frequent gross total resection and irradiation. We showed that an optimal therapeutic combination of radio-chemotherapy could be safe and feasible for these elderly patients to aid in their management. Finally, we identified specific geriatric prognostic factors such as mobility, neuropsychological disorders, body mass index, and autonomy that can help physicians make future therapeutic decisions for this specific elderly population with a better prognosis. ABSTRACT: Background: Describe the characteristics, patterns of care, and predictive geriatric factors of elderly patients with IDHm high-grade glioma (HGG) included in the French POLA network. Material and Methods: The characteristics of elderly (≥70 years) patients IDHm HGG were compared to those of younger patients IDHm HGG (<70 years) and of elderly patients IDHwt HGG. Geriatric features were collected. Results: Out of 1433 HGG patients included, 119 (8.3%) were ≥70 years. Among them, 39 presented with IDHm HGG. The main characteristics of elderly IDHm HGG were different from those of elderly IDHwt HGG but similar to those of younger IDHm HGG. In contrast, their therapeutic management was different from those of younger IDHm HGG with less frequent gross total resection and radiotherapy. The median progression-free survival (PFS) and overall survival (OS) were longer for elderly patients IDHm HGG (29.3 months and 62.1 months) than elderly patients IDHwt HGG (8.3 months and 13.3 months) but shorter than those of younger patients IDHm HGG (69.1 months and not reached). Geriatric factors associated with PFS and OS were mobility, neuropsychological disorders, body mass index, and autonomy. Geriatric factors associated with PFS and OS were mobility, neuropsychological disorders, and body mass index, and autonomy. Conclusion: the outcome of IDHm HGG in elderly patients is better than that of IDHwt HGG. Geriatric assessment may be particularly important to optimally manage these patients.