{"entity":{"id":"paper-noa-08-temozolomide-vs-radiotherapy-elderly-wick-lancet-oncol-2012","kind":"paper","name":"NOA-08: temozolomide alone versus radiotherapy alone for malignant astrocytoma in the elderly","aka":[],"tldr":"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.\n\nMedian 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).","asOf":"2026-09-22","links":[{"label":"Lancet Oncol 2012","url":"https://doi.org/10.1016/S1470-2045(12)70164-X"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/22578793/"}],"tags":[],"related":[],"cancers":["glioblastoma"],"sections":[],"technologies":[],"targets":[],"drugs":["temozolomide"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["noa-08"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet-oncology"],"dependsOn":[],"notes":[],"journal":"The Lancet Oncology","year":2012,"doi":"10.1016/S1470-2045(12)70164-X","pmid":"22578793","authors":"Wick W, Platten M, Meisner C, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":412},"route":"/key-papers/paper-noa-08-temozolomide-vs-radiotherapy-elderly-wick-lancet-oncol-2012/","neighbours":{"cancer":[{"id":"glioblastoma","kind":"cancer","name":"Glioma & glioblastoma","route":"/cancers/glioblastoma/"}],"drug":[{"id":"temozolomide","kind":"drug","name":"Temozolomide","route":"/drugs/temozolomide/"}],"trial":[{"id":"noa-08","kind":"trial","name":"NOA-08","route":"/trials/noa-08/"}],"journal":[{"id":"lancet-oncology","kind":"journal","name":"The Lancet Oncology","route":"/journals/lancet-oncology/"}]}}