# NOA-08: temozolomide alone versus radiotherapy alone for malignant astrocytoma in the elderly

Source: https://onco.cc/key-papers/paper-noa-08-temozolomide-vs-radiotherapy-elderly-wick-lancet-oncol-2012/  
OnCo record `paper-noa-08-temozolomide-vs-radiotherapy-elderly-wick-lancet-oncol-2012` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Older people with glioblastoma lived as long on temozolomide tablets as on radiotherapy, and the MGMT test showed who should get which: methylated tumours did better with the chemotherapy and unmethylated tumours with radiotherapy.

## Summary

Randomised phase 3 non-inferiority trial of the German Neuro-oncology Working Group in 412 patients over 65 with anaplastic astrocytoma or glioblastoma, comparing dose-dense temozolomide (one week on, one week off) with radiotherapy of 60 Gy; 373 patients were treated and analysed.

Median overall survival was 8.6 months with temozolomide against 9.6 months with radiotherapy (hazard ratio 1.09), meeting non-inferiority, and event-free survival did not differ. MGMT promoter methylation was associated with longer survival and predicted benefit from temozolomide (event-free survival 8.4 against 4.6 months), while unmethylated tumours did better with radiotherapy (3.3 against 4.6 months).

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet Oncology
- Year: 2012
- DOI: 10.1016/S1470-2045(12)70164-X
- Authors: Wick W, Platten M, Meisner C, et al.
- Findings: Median overall survival 8.6 months (95% CI 7.3 to 10.2) with temozolomide versus 9.6 months (8.2 to 10.8) with radiotherapy; hazard ratio 1.09 (0.84 to 1.42), non-inferior.; MGMT promoter methylation: event-free survival 8.4 months with temozolomide versus 4.6 with radiotherapy; unmethylated: 3.3 versus 4.6 months.; More grade 3 to 4 haematological toxicity, infections and thromboembolic events with temozolomide.
- What it means: With the Nordic trial, NOA-08 made MGMT testing the way to choose between temozolomide alone and radiotherapy alone for older patients with glioblastoma who are not offered combined treatment.
- Caveats: Non-inferiority design with a dose-dense temozolomide schedule that is no longer standard.; The combined short-course radiotherapy plus temozolomide approach was tested separately (CE.6) and is preferred for fit older patients.

## Sources

- Lancet Oncol 2012: https://doi.org/10.1016/S1470-2045(12)70164-X
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22578793/

## Connected records

- cancers: [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/)
- drugs: [Temozolomide](https://onco.cc/drugs/temozolomide/)
- trials: [NOA-08](https://onco.cc/trials/noa-08/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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