Therapeutic options in recurrent glioblastoma—An update

Seystahl, Katharina; Wick, Wolfgang; Weller, Michael

doi:10.1016/j.critrevonc.2016.01.018

Cited by 171 publications

(132 citation statements)

References 145 publications

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“…Chemotherapy with temozolomide improves overall survival (OS) time predominantly in patients with glioblastoma that harbor a methylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter (10,11). Even in these patients, tumor progression is inevitable; at first progression, median progression-free survival (PFS) and median overall survival (OS) times typically reach 2-3 and 8-9 months, respectively (12). At progression, gross total resection can be achieved again in certain patients (13).…”

Section: Introductionmentioning

confidence: 99%

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Bevacizumab as a last-line treatment for glioblastoma following failure of radiotherapy, temozolomide and lomustine

et al. 2017

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Abstract. In previous trials, bevacizumab failed to prolong the overall survival time in newly diagnosed glioblastoma and at the first recurrence. Randomized clinical trials at the second or further recurrence following the failure of radiotherapy, temozolomide and lomustine, and retrospective analyses focusing on this specific cohort, are not yet available. A total of 62 patients with glioblastoma who received bevacizumab after the failure of standard care, including radiotherapy, temozolomide and lomustine, were retrospectively identified. Patient characteristics, previous treatment details, concomitant therapy, response based on the Response Assessment in Neuro-Oncology criteria, and progression-free survival (PFS) and overall survival (OS) times and rates were evaluated. Furthermore, the PFS and OS times and rates were analyzed for responders and non-responders. Of the patients, 54.8% (n=34) responded to treatment [complete response (CR) 3.2%, n=2; partial response (PR) 51.6%, n=32]. The median PFS time was 3.5 months and the median OS time was 7.5 months. The PFS rate at 6 months was 21.5% and the OS rate at 12 months was 11.5%. Responders (CR or PR) experienced a superior median PFS time compared with non-responders (i.e. stable or progressive disease; 5.4 vs. 1.9 months; P<0.0001) and a superior PFS rate at 6 months (34.9 vs. 7.1%; P<0.0001). The median OS time (8.6 vs. 6.4 months; P<0.0001) and OS rate at 12 months (21.3 vs. 0%; P<0.0001) were also superior in patients who exhibited a response to bevacizumab treatment. In conclusion, the objective response rate and the PFS and OS times and rates indicate that bevacizumab has activity in patients with glioblastoma following the failure of radiotherapy, temozolomide, and lomustine. A randomized trial comparing bevacizumab with best supportive care in these patients is advised.

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Section: Introductionmentioning

confidence: 99%

“…Re-irradiation is also applied when technically possible (14). Temozolomide rechallenge and lomustine chemotherapy are frequently used to treat recurrent glioblastoma (12,15). Nonetheless, as demonstrated by low PFS and OS times, the efficacy of all approaches at recurrence is limited (12).…”

Section: Introductionmentioning

confidence: 99%

Bevacizumab as a last-line treatment for glioblastoma following failure of radiotherapy, temozolomide and lomustine

et al. 2017

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“…The impact of repeat surgery on the outcome of patients suffering from HGGs has been the long-standing matter of ongoing debate, with studies giving diverse results. 13 Recent studies, though, suggested that an increased extent of resection (EOR) is a favorable prognostic factor, not only for GBM patients undergoing initial resection, but also in case of tumor recurrence and that repeat surgery is associated with an acceptable treatment-associated morbidity. 4,14,15 Furthermore, Suchorska et al reported that patients undergoing complete resection of the contrast-enhancing tumor recurrence were found to display improved PRS as well as quality of life (QoL) compared to those with no/subtotal resection.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Therapeutic Options for Recurrent High-Grade Gliomas: A Perspective Statement

2017

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“…During follow-up of GBM patients, most oncologists will perform an MRI scan every 2-3 months, or earlier upon clinical deterioration (8). This regular MRI scan will detect many recurrences in the early phase, often in asymptomatic patients.…”

Section: Radiological Diagnosis Of a Recurrence In Clinical Practicementioning

confidence: 99%

Recurring Glioblastoma: A Case for Reoperation?

Dejaegher

Vleeschouwer

2017

Glioblastoma

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Unlike newly diagnosed glioblastoma, no clear or widely accepted standard of care is available for patients with a recurrence. A purely radiological diagnosis of recurrence or progression can be hampered by flaws induced by pseudoprogression, pseudoresponse, or radionecrosis. Based on parameters like tumor location and volume, patient' s performance status, time from initial diagnosis, and availability of alternative salvage therapies, reoperation can be considered as a treatment option to extend the overall survival and quality of life of the patient. The achieved extent of resection of the relapsed tumor-especially with the intention of having a safe, complete resection of the enhancing tumor-most likely plays a crucial role in the ultimate outcome and prognosis of the patient, regardless of other modes of treatment. Validated scores to predict the prognosis after reoperation of a patient with a recurrent glioblastoma can help to select suitable candidates for surgery. Safety issues and complication avoidance are pivotal to maximally preserve the patient' s quality of life. Besides a possible direct oncological effect, resampling of the recurrent tumor with detailed pathological and molecular analysis might have an impact on the development, testing, and validation of new salvage therapies.

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Therapeutic options in recurrent glioblastoma—An update

Abstract: ConclusionProper patient selection, development of predictive biomarkers and randomized controlled studies are required to develop evidence-based concepts for recurrent glioblastoma.

Cited by 171 publications

References 145 publications

Bevacizumab as a last-line treatment for glioblastoma following failure of radiotherapy, temozolomide and lomustine

Bevacizumab as a last-line treatment for glioblastoma following failure of radiotherapy, temozolomide and lomustine

Therapeutic Options for Recurrent High-Grade Gliomas: A Perspective Statement

Recurring Glioblastoma: A Case for Reoperation?

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