Temozolomide vs RT in the Elderly with GBM

In the Lancet Oncology this week:

A trial from German is published reported the results of a phase III trial of RT alone vs Temozolomide alone in the elderly.  They find that temozolomide is "non-inferior" to RT alone - however, they define "non-inferior"as not >25% worse that RT.  This would be a hard sell for a new standard therapy in almost any other setting, and if one looks at the survival curves, RT does appear to do better for the first 6 months or so for RFS, and most paitents crossed over so that most patients on this trial eventually recieved both.  I find the MGMT findings quite interesting (though only 'hypothesis generating'), in that MGMT methylation predicted for a benefit of temozolomide alone, but had little predictive power in the RT alone group.   The larger question I guess is that if most of these patients received both treatments anyway, why not have a go at concurrent treatment for the most benefit?

Link:

[Articles] Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial: Temozolomide alone is non-inferior to radiotherapy alone in the treatment of elderly patients with malignant astrocytoma. MGMT promoter methylation seems to be a useful biomarker for outcomes by treatment and could aid decision-making.