{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:00:16Z","timestamp":1785387616325,"version":"3.55.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"\n Background<\/jats:title>\n The prognosis for very elderly patients with glioblastoma (GBM) is extremely poor. For patients with a high tumor burden, multiple severe comorbidities, and poor physical condition, standard surgery and chemoradiotherapy are often poorly tolerated, and there is an urgent need for effective, low-toxicity palliative treatment options.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n \n The patient is an 85-year-old man who presented with progressive speech difficulty. Imaging revealed a large left frontal lobe GBM measuring 6.4\u00a0cm \u00d7 6.0\u00a0cm with intratumoral hemorrhage. Molecular testing showed positive\n O<\/jats:italic>\n 6<\/jats:sup>\n -methylguanine-DNA methyltransferase (MGMT) promoter methylation, wild-type IDH1\/2, and negative BRAF V600E. The patient had multiple severe comorbidities, including epilepsy, congestive heart failure, type 2 diabetes mellitus, cerebral infarction, and severe malnutrition. The baseline Eastern Cooperative Oncology Group (ECOG) score was 4, and the Karnofsky Performance Status (KPS) score was 30; after systematic treatment, follow-up showed an ECOG score of 3 and a KPS score of 50. Treatment and outcome: Starting from 25 December 2024, palliative treatment was initiated with metronomic low-dose temozolomide (50 mg\/day, continuous oral administration without dose reduction or interruption) combined with sodium valproate (0.4 g\/dose, three times daily, administered via nasogastric tube). Concurrently, standard symptomatic and supportive treatments were given, including osmotic dehydration with mannitol and low-dose dexamethasone (corticosteroids). Because of the patient\u2019s critical condition and inability to be transported or undergo MRI, imaging efficacy evaluation was performed solely using head CT scans, and the MRI-RANO response criteria could not be applied. The regimen was well tolerated, with no myelosuppression or abnormal liver function. At the 3-month follow-up, serial head CT scans indicated stable disease without progression; ECOG and KPS scores showed significant improvement compared to baseline.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Low-dose metronomic temozolomide combined with sodium valproate is a safe and feasible palliative treatment strategy for very elderly GBM patients with MGMT promoter methylation, poor physical condition, and an inability to tolerate standard therapy. This study is a single-case report, and the conclusions have limitations, requiring validation through large-sample clinical studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fonc.2026.1853109","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:22:02Z","timestamp":1785385322000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-dose temozolomide combined with valproic acid in the treatment of an elderly patient with MGMT-methylated glioblastoma and multiple comorbidities: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Lisi","family":"Gan","sequence":"first","affiliation":[{"name":"Department of Oncology, The Third People's Hospital of Hubei Province","place":["Wuhan, Hubei, China"]},{"name":"Hubei University of Medicine","place":["Shiyan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanling","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Third People's Hospital of Hubei Province","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/cells14221764","article-title":"Role of the interplay between autophagy and cellular senescence in the pathogenesis and therapeutics of glioblastoma in the aging population","volume":"14","author":"Masliah","year":"2025","journal-title":"Cells"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14102412","article-title":"Epidemiology of glioblastoma multiforme\u2014literature review","volume":"14","author":"Grochans","year":"2022","journal-title":"Cancers 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