Temozolomide use in elderly patients with MGMT promoter unmethylated glioblastoma: Is it finally time to dismount a dead horse?
Bibliographic record
Abstract
Temozolomide (TMZ) remains the only chemotherapy agent associated with a survival benefit in glioblastoma (GBM). In the landmark “Stupp” study, the median overall survival (mOS) was 14.6 months for patients treated with radiation therapy (RT) and TMZ compared to 12.1 months for patients treated with RT alone.1 Epigenetic silencing via methylation within the CpG island of the promoter region of the O6-methylguanine DNA methyltransferase (MGMT) gene was associated with significantly improved outcomes in the RT/TMZ arm. Patients with MGMT promoter methylated tumors treated with RT/TMZ had an mOS of 21.7 months as compared with 15.6 months for those treated with RT alone, while those with MGMT promoter unmethylated tumors had a marginal survival benefit (12.7 vs. 11.8 months, respectively; P = .06).2 However, in this trial, 10% of patients with MGMT unmethylated tumors treated with RT/TMZ were alive at 3 years. Coupled with the mild toxicities and absence of compelling alternatives, these data have driven the routine use of TMZ in clinical practice regardless of MGMT status.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".