Treatment options for progression or recurrence of glioblastoma: a network meta-analysis

McBain, Catherine; Lawrie, Theresa A; Rogozińska, Ewelina; Kernohan, Ashleigh; Robinson, Tomos; Jefferies, Sarah

doi:10.1002/14651858.cd013579.pub2

Cited by 65 publications

(48 citation statements)

References 166 publications

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“…This reflects the predominance of UK and European responders to our questionnaire. Single agent Lomustine at progression is most commonly used in North America and is the most common comparator for novel agents in randomised controlled trials of progression [31]. Any surgical trial will need to account for or control these variations in practice.…”

Section: Discussionmentioning

confidence: 99%

Second surgery for progressive glioblastoma: a multi‐centre questionnaire and cohort‐based review of clinical decision‐making and patient outcomes in current practice

et al. 2021

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Purpose Glioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. Methods Current practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. Results 234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p = 0.874). Conclusions This is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

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Section: Discussionmentioning

confidence: 99%

Second surgery for progressive glioblastoma: a multi‐centre questionnaire and cohort‐based review of clinical decision‐making and patient outcomes in current practice

et al. 2021

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“…Recently, a network meta-analysis demonstrated that lomustine appears to be the most effective chemotherapy treatment and other combination therapies tested (BEV monotherapy, BEV plus lomustine, bevacizumab and irinotecan, regorafenib, TMZ plus Depatux-M, and fotemustine) had a higher risk of serious side effects for treatment of first recurrence of GBM [161].…”

Section: Development Of New Drugs For Glioblastoma Treatmentmentioning

confidence: 99%

Obstacles to Glioblastoma Treatment Two Decades after Temozolomide

Cruz

Batista

Afonso

et al. 2022

Cancers

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Glioblastomas are considered the most common and aggressive primary brain tumor in adults, with an average of 15 months’ survival rate. The treatment is surgery resection, followed by chemotherapy with temozolomide, and/or radiotherapy. Glioblastoma must have wild-type IDH gene and some characteristics, such as TERT promoter mutation, EGFR gene amplification, microvascular proliferation, among others. Glioblastomas have great heterogeneity at cellular and molecular levels, presenting distinct phenotypes and diversified molecular signatures in each tumor mass, making it difficult to define a specific therapeutic target. It is believed that the main responsibility for the emerge of these distinct patterns lies in subcellular populations of tumor stem cells, capable of tumor initiation and asymmetric division. Studies are now focused on understanding molecular mechanisms of chemoresistance, the tumor microenvironment, due to hypoxic and necrotic areas, cytoskeleton and extracellular matrix remodeling, and in controlling blood brain barrier permeabilization to improve drug delivery. Another promising therapeutic approach is the use of oncolytic viruses that are able to destroy specifically glioblastoma cells, preserving the neural tissue around the tumor. In this review, we summarize the main biological characteristics of glioblastoma and the cutting-edge therapeutic targets that are currently under study for promising new clinical trials.

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“…Such shortcomings in clinical trial design and therapeutic evaluation should now be behind us, and the stage is ready for more rapid drug discovery in “window of opportunity” studies and adaptive platform clinical trial designs. It remains implausible to think that one single targeted therapy will move the needle in the overall survival from recurrent GBM [ 258 ]; but our field has made little effort to understand whether specifically defined subgroups of patients may demonstrate benefit despite negative phase III results. The proverbial “throwing out the baby with the bathwater” approach to failed clinical trials should not be an acceptable outcome of these efforts.…”

Section: Future Directionsmentioning

confidence: 99%

Updates in IDH-Wildtype Glioblastoma

et al. 2022

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Glioblastoma is the most aggressive primary brain tumor with a poor prognosis. The 2021 WHO CNS5 classification has further stressed the importance of molecular signatures in diagnosis although therapeutic breakthroughs are still lacking. In this review article, updates on the current and novel therapies in IDH-wildtype GBM will be discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s13311-022-01251-6.

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Treatment options for progression or recurrence of glioblastoma: a network meta-analysis

Cited by 65 publications

References 166 publications

Second surgery for progressive glioblastoma: a multi‐centre questionnaire and cohort‐based review of clinical decision‐making and patient outcomes in current practice

Second surgery for progressive glioblastoma: a multi‐centre questionnaire and cohort‐based review of clinical decision‐making and patient outcomes in current practice

Obstacles to Glioblastoma Treatment Two Decades after Temozolomide

Updates in IDH-Wildtype Glioblastoma

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