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An algorithm for chemotherapy treatment of recurrent glioma patients after temozolomide failure in the general oncology setting

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Abstract

Purpose

The standard therapy for newly diagnosed malignant gliomas comprises surgery, radiotherapy, and commonly temozolomide chemotherapy. For recurrent or progressive disease after temozolomide failure, there is no consensus and only limited options for chemotherapy.

Methods

We reviewed the English literature for phase II trials of therapies for recurrent malignant glioma conducted between January 2000 and September 2010. The search was supplemented by a review of articles published prior to 2000 on chemotherapy regimens that had shown activity on recurrent gliomas.

Results

To guide practice in the general oncology setting, an algorithm was constructed according to the activity of the reported chemotherapies at the time of writing. Some molecular studies performed on tumor tissue may help guide the selection of chemotherapy. Methylated MGMT in tumor tissue correlates with increased sensitivity to alkylating agents such as fotemustine or other nitrosoureas. Depending on MGMT status and bone marrow reserve, treatment with fotemustine, bevacizumab, bevacizumab with irinotecan, or cis-retinoic acid (cRA), might be of value.

Conclusion

Unfortunately, progress in the development of new and more effective chemotherapy agents has been very limited and leaves the clinician treating high-grade glioma patients at relapse with few good options. The suggested algorithm is our objective evaluation of the currently existing knowledge. Hopefully, the ongoing phase II and III trials will provide us the needed chemotherapy agents in the years to come.

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Authors and Affiliations

  1. Neurosurgical Research Institute, University of Ioannina, Ioannina, 45110, Greece

    Athanassios P. Kyritsis

  2. Department of Neurology, University of Ioannina School of Medicine, University Campus, Ioannina, 45110, Greece

    Athanassios P. Kyritsis

  3. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Victor A. Levin

  4. Kaiser Permanente, Redwood City, CA, 94063, USA

    Victor A. Levin

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Kyritsis, A.P., Levin, V.A. An algorithm for chemotherapy treatment of recurrent glioma patients after temozolomide failure in the general oncology setting. Cancer Chemother Pharmacol 67, 971–983 (2011). https://doi.org/10.1007/s00280-011-1617-9

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