Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of cytotoxic chemotherapy and other cytotoxic therapies in the management of progressive glioblastoma in adults

Germano, Isabelle M.; Ziu, Mateo; Wen, Patrick Y.; Ormond, D. Ryan; Olson, Jeffrey J.

doi:10.1007/s11060-021-03900-w

Cited by 9 publications

(11 citation statements)

References 59 publications

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“…Intracranial infection and abnormal wound healing may occur in this treatment regimen [ 36 , 37 , 38 , 39 , 40 ]. Lomustine and Fotemustine are other important alkylating agents used orally in the treatment of recurrent GBM that can cross the blood–brain barrier due to small size and high lipophilicity [ 41 , 42 , 43 ].…”

Section: Conventional Treatment Optionsmentioning

confidence: 99%

Mechanisms of Resistance and Current Treatment Options for Glioblastoma Multiforme (GBM)

Yalamarty

Filipczak

et al. 2023

Cancers

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Glioblastoma multiforme (GBM) is a highly aggressive form of brain cancer that is difficult to treat due to its resistance to both radiation and chemotherapy. This resistance is largely due to the unique biology of GBM cells, which can evade the effects of conventional treatments through mechanisms such as increased resistance to cell death and rapid regeneration of cancerous cells. Additionally, the blood–brain barrier makes it difficult for chemotherapy drugs to reach GBM cells, leading to reduced effectiveness. Despite these challenges, there are several treatment options available for GBM. The standard of care for newly diagnosed GBM patients involves surgical resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy. Emerging treatments include immunotherapy, such as checkpoint inhibitors, and targeted therapies, such as bevacizumab, that attempt to attack specific vulnerabilities in GBM cells. Another promising approach is the use of tumor-treating fields, a type of electric field therapy that has been shown to slow the growth of GBM cells. Clinical trials are ongoing to evaluate the safety and efficacy of these and other innovative treatments for GBM, intending to improve with outcomes for patients.

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Section: Conventional Treatment Optionsmentioning

confidence: 99%

Mechanisms of Resistance and Current Treatment Options for Glioblastoma Multiforme (GBM)

Yalamarty

Filipczak

et al. 2023

Cancers

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“…Such emerging technologies span intraoperative tools to maximize cytoreduction, advanced radiotherapy techniques to minimize toxicity and/or treat recurrence, locoregional chemoradiation to bridge systemic therapies, and adjunct devices with novel anticancer mechanisms like thermal ablation [8][9][10][11][12][13][14][15]. While the therapeutic benefits of some of these tools have been endorsed in clinical practice guidelines, they remain largely investigational for use in the posterior fossa [14][15][16][17].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15] While the therapeutic benefits of some of these tools have been endorsed in clinical practice guidelines, they remain largely investigational for use in the posterior fossa. [14][15][16][17] Herein, we present the first report of a rare IDH-mutated grade 4 astrocytoma in the CPA and perform a systematic review of the literature for all cases of exophytic grade 4 astrocytomas of any molecular subtype in this region. Given the anatomic complexity of the cranial base, the primary focus of this study was to evaluate treatment strategies, including the use and feasibility of emerging operative adjuncts, for high-grade CPA astrocytomas.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of WHO Grade 4 Astrocytoma in the Cerebellopontine Angle: The Impact of Anatomic Corridor on Treatment Options and Outcomes

Dang,

Gong,

Dang

et al. 2023

J Neurol Surg Rep

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Background: Despite advances in multimodal oncologic therapies and molecular genetics, overall survival (OS) for high-grade astrocytomas remains poor. We present an illustrative case and systematic review of rare, predominantly extra-axial WHO grade 4 astrocytomas located within the cerebellopontine angle (CPA) and explore the impact of anatomic location on diagnosis, management, and outcomes. Methods: A systematic review of adult patients with predominantly extra-axial WHO grade 4 CPA astrocytomas was conducted following the PRISMA guidelines through December 2022. Results: 18 articles were included comprising 21 astrocytomas: 13 exophytic tumors arising from cerebellopontine parenchyma, and 8 tumors originating from a cranial nerve root entry zone. Median OS was 15 months with one-third of cases demonstrating delayed diagnosis. Gross total resection, molecular genetic profiling, and use of ancillary treatment were low. We report the only patient with an integrated IDH-1 mutant diagnosis, who, after subtotal resection and chemoradiation, remains alive at 40 months without progression. Conclusion: The deep conical-shaped corridor and abundance of eloquent tissue of the CPA significantly limits both surgical resection and utility of device-based therapies in this region. Prompt diagnosis, molecular characterization, and systemic therapeutic advances serve as the predominant means to optimize survival for patients with rare skull base astrocytomas.

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“…For the purpose of this section, we reviewed four recent publications that we considered pivotal in the field of neuro-oncology, given their fundamental contribution to the understanding and management of progressive GBM [ 124 , 125 , 126 , 127 ]. In the pursuit to portray the most crucial and factual evidence regarding the multimodal management of rGBM, we hereby summarize the salient findings reported by the Congress of Neurological Surgeons (CNS) and EANO guidelines of the last two years.…”

Section: Current Guidelines For the Treatment Of Rgbmmentioning

confidence: 99%

Recurrent Glioblastoma Treatment: State of the Art and Future Perspectives in the Precision Medicine Era

et al. 2022

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Current treatment guidelines for the management of recurrent glioblastoma (rGBM) are far from definitive, and the prognosis remains dismal. Despite recent advancements in the pharmacological and surgical fields, numerous doubts persist concerning the optimal strategy that clinicians should adopt for patients who fail the first lines of treatment and present signs of progressive disease. With most recurrences being located within the margins of the previously resected lesion, a comprehensive molecular and genetic profiling of rGBM revealed substantial differences compared with newly diagnosed disease. In the present comprehensive review, we sought to examine the current treatment guidelines and the new perspectives that polarize the field of neuro-oncology, strictly focusing on progressive disease. For this purpose, updated PRISMA guidelines were followed to search for pivotal studies and clinical trials published in the last five years. A total of 125 articles discussing locoregional management, radiotherapy, chemotherapy, and immunotherapy strategies were included in our analysis, and salient findings were critically summarized. In addition, an in-depth description of the molecular profile of rGBM and its distinctive characteristics is provided. Finally, we integrate the above-mentioned evidence with the current guidelines published by international societies, including AANS/CNS, EANO, AIOM, and NCCN.

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Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of cytotoxic chemotherapy and other cytotoxic therapies in the management of progressive glioblastoma in adults

Cited by 9 publications

References 59 publications

Mechanisms of Resistance and Current Treatment Options for Glioblastoma Multiforme (GBM)

Mechanisms of Resistance and Current Treatment Options for Glioblastoma Multiforme (GBM)

Systematic Review of WHO Grade 4 Astrocytoma in the Cerebellopontine Angle: The Impact of Anatomic Corridor on Treatment Options and Outcomes

Recurrent Glioblastoma Treatment: State of the Art and Future Perspectives in the Precision Medicine Era

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