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Current Medical Treatment of Glioblastoma

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Current Understanding and Treatment of Gliomas

Abstract

Glioblastoma is the most common adult malignant primary brain tumor. Despite the advances in therapeutic options, survival of patients with glioblastoma remains dismal at 15–18 months. Current standard of care for newly diagnosed glioblastoma is maximal possible safe resection consistent with the preservation of neurologic function followed by concurrent temozolomide with radiation and adjuvant. Treatment options at recurrence include surgical resection with or without the placement of carmustine wafers, re-irradiation and chemotherapeutics such as nitrosoureas (lomustine, carmustine) or bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF).

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References

  1. Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  CAS  PubMed  Google Scholar 

  2. Stupp R, Hegi ME, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466

    Article  CAS  PubMed  Google Scholar 

  3. Hegi ME, Diserens AC, Gorlia T et al (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352:997–1003

    Article  CAS  PubMed  Google Scholar 

  4. Clarke JL, Iwamoto FM, Sul J et al (2009) Randomized phase II trial of chemoradiotherapy followed by either dose-dense or metronomic temozolomide for newly diagnosed glioblastoma. J Clin Oncol 27:3861–3867

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Gilbert MR, Wang M, Aldape KD et al (2013) Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial. J Clin Oncol 31:4085–4091

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Chalmers AJ (2009) The potential role and application of PARP inhibitors in cancer treatment. Br Med Bull 89:23–40

    Article  CAS  PubMed  Google Scholar 

  7. Dungey FA, Loser DA, Chalmers AJ (2008) Replication-dependent radiosensitization of human glioma cells by inhibition of poly(ADP-ribose) polymerase: mechanisms and therapeutic potential. Int J Radiat Oncol Biol Phys 72:1188–1197

    Article  CAS  PubMed  Google Scholar 

  8. Sandhu SK, Yap TA, de Bono JS (2010) Poly(ADP-ribose) polymerase inhibitors in cancer treatment: a clinical perspective. Eur J Cancer 46:9–20

    Article  CAS  PubMed  Google Scholar 

  9. Westphal M, Hilt DC, Bortey E et al (2003) A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro-oncology 5:79–88

    CAS  PubMed Central  PubMed  Google Scholar 

  10. Duntze J, Litre CF, Eap C et al (2013) Implanted carmustine wafers followed by concomitant radiochemotherapy to treat newly diagnosed malignant gliomas: prospective, observational, multicenter study on 92 cases. Ann Surg Oncol 20:2065–2072

    Article  PubMed  Google Scholar 

  11. Folkman J (1971) Tumor angiogenesis: therapeutic implications. N Engl J Med 285:1182–1186

    Article  CAS  PubMed  Google Scholar 

  12. Carmeliet P, Jain RK (2011) Molecular mechanisms and clinical applications of angiogenesis. Nature 473:298–307

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Ahluwalia MS, Gladson CL (2010) Progress on antiangiogenic therapy for patients with malignant glioma. J Oncol 2010:689018

    Article  PubMed Central  PubMed  Google Scholar 

  14. Kleihues P, Louis DN, Scheithauer BW et al (2002) The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:215–225

    Google Scholar 

  15. Wen PY, Kesari S (2008) Malignant gliomas in adults. N Engl J Med 359:492–507

    Article  CAS  PubMed  Google Scholar 

  16. Seidel S, Garvalov BK, Wirta V et al (2010) A hypoxic niche regulates glioblastoma stem cells through hypoxia inducible factor 2 alpha. Brain 133:983–995

    Article  PubMed  Google Scholar 

  17. Nam DH, Park K, Suh YL, Kim JH (2004) Expression of VEGF and brain specific angiogenesis inhibitor-1 in glioblastoma: prognostic significance. Oncol Rep 11:863–869

    CAS  PubMed  Google Scholar 

  18. Robles Irizarry L, Hambardzumyan D, Nakano I, Gladson CL, Ahluwalia MS (2012) Therapeutic targeting of VEGF in the treatment of glioblastoma. Expert Opin Ther Targets 16:973–984

    Article  CAS  PubMed  Google Scholar 

  19. Gilbert MR, Dignam JJ, Armstrong TS et al (2014) A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med 370:699–708

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Chinot OL, Wick W, Mason W et al (2014) Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med 370:709–722

    Article  CAS  PubMed  Google Scholar 

  21. Herrlinger U, Schaefer N, Steinbach JP et al (2013) Bevacizumab, irinotecan, and radiotherapy versus standard temozolomide and radiotherapy in newly diagnosed, MGMT-non-methylated glioblastoma patients: first results from the randomized multicenter GLARIUS trial. J Clin Oncol (Meeting Abstracts):31(18_suppl LBA2000)

    Google Scholar 

  22. Reardon DA, Fink KL, Mikkelsen T et al (2008) Randomized phase II study of cilengitide, an integrin-targeting arginine-glycine-aspartic acid peptide, in recurrent glioblastoma multiforme. J Clin Oncol 26:5610–5617

    Article  CAS  PubMed  Google Scholar 

  23. Stupp R, Hegi ME, Neyns B et al (2010) Phase I/IIa study of cilengitide and temozolomide with concomitant radiotherapy followed by cilengitide and temozolomide maintenance therapy in patients with newly diagnosed glioblastoma. J Clin Oncol 28:2712–2718

    Article  CAS  PubMed  Google Scholar 

  24. Stupp R, Hegi ME, Gorlia T et al (2013) Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma and methylated O6-methylguanine-DNA methyltransferase (MGMT) gene promoter: key results of the multicenter, randomized, open-label, controlled, phase III CENTRIC study. J Clin Oncol (Meeting Abstracts):31(18_suppl LBA2009)

    Google Scholar 

  25. Nabors LB, Fink KL, Mikkelsen T et al (2013) Randomized phase II study investigating cilengitide added to standard chemoradiotherapy in patients with newly diagnosed glioblastoma with unmethylated 06-methylguanine-DNA methyltransferase (MGMT) gene promoter: initial report of the CORE study. In: European cancer congress, Amsterdam

    Google Scholar 

  26. Brandes AA, Tosoni A, Amista P et al (2004) How effective is BCNU in recurrent glioblastoma in the modern era? a phase II trial. Neurology 63:1281–1284

    Article  CAS  PubMed  Google Scholar 

  27. Wick W, Puduvalli VK, Chamberlain MC et al (2010) Phase III study of enzastaurin compared with lomustine in the treatment of recurrent intracranial glioblastoma. J Clin Oncol 28:1168–1174

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Field KM, Simes J, Wheeler H et al (2013) A randomized phase II study of carboplatin and bevacizumab in recurrent glioblastoma multiforme (CABARET). J Clin Oncol (Meeting Abstracts):31(15_suppl 2017)

    Google Scholar 

  29. Schmidt F, Fischer J, Herrlinger U, Dietz K, Dichgans J, Weller M (2006) PCV chemotherapy for recurrent glioblastoma. Neurology 66:587–589

    Article  CAS  PubMed  Google Scholar 

  30. Wick A, Felsberg J, Steinbach JP et al (2007) Efficacy and tolerability of temozolomide in an alternating weekly regimen in patients with recurrent glioma. J Clin Oncol 25:3357–3361

    Article  CAS  PubMed  Google Scholar 

  31. Norden AD, Lesser GJ, Drappatz J et al (2013) Phase 2 study of dose-intense temozolomide in recurrent glioblastoma. Neuro Oncol 15:930–935

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Perry JR, Belanger K, Mason WP et al (2010) Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol 28:2051–2057

    Article  CAS  PubMed  Google Scholar 

  33. Omuro A, Chan TA, Abrey LE et al (2013) Phase II trial of continuous low-dose temozolomide for patients with recurrent malignant glioma. Neuro Oncol 15:242–250

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Brem H, Piantadosi S, Burger PC et al (1995) Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The polymer-brain tumor treatment group. Lancet 345:1008–1012

    Article  CAS  PubMed  Google Scholar 

  35. Stark-Vance V (2005) Bevacizumab and CPT-11 in the treatment of relapsed malignant glioma. Neuro Oncol 7:369

    Google Scholar 

  36. Vredenburgh JJ, Desjardins A, Herndon JE 2nd et al (2007) Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 25:4722–4729

    Article  CAS  PubMed  Google Scholar 

  37. Friedman HS, Prados MD, Wen PY et al (2009) Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol 27:4733–4740

    Article  CAS  PubMed  Google Scholar 

  38. Kreisl TN, Kim L, Moore K et al (2009) Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol 27:740–745

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Reardon DA, Desjardins A, Vredenburgh JJ et al (2009) Metronomic chemotherapy with daily, oral etoposide plus bevacizumab for recurrent malignant glioma: a phase II study. Br J Cancer 101:1986–1994

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Reardon DA, Desjardins A, Peters KB et al (2012) Phase II study of carboplatin, irinotecan, and bevacizumab for bevacizumab naive, recurrent glioblastoma. J Neurooncol 107:155–164

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Desjardins A, Reardon DA, Coan A et al (2012) Bevacizumab and daily temozolomide for recurrent glioblastoma. Cancer 118:1302–1312

    Article  CAS  PubMed  Google Scholar 

  42. Raizer JJ, Grimm S, Chamberlain MC et al (2010) A phase 2 trial of single-agent bevacizumab given in an every-3-week schedule for patients with recurrent high-grade gliomas. Cancer 116:5297–5305

    Article  CAS  PubMed  Google Scholar 

  43. Bokstein F, Shpigel S, Blumenthal DT (2008) Treatment with bevacizumab and irinotecan for recurrent high-grade glial tumors. Cancer 112:2267–2273

    Article  CAS  PubMed  Google Scholar 

  44. Taal W, Oosterkamp HM, Walenkamp AME et al (2013) A randomized phase II study of bevacizumab versus bevacizumab plus lomustine versus lomustine single agent in recurrent glioblastoma: the Dutch BELOB study. J Clin Oncol (Meeting Abstracts):31(15_suppl 2001)

    Google Scholar 

  45. Batchelor TT, Sorensen AG, di Tomaso E et al (2007) AZD2171, a pan-VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients. Cancer Cell 11:83–95

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Batchelor TT, Mulholland P, Neyns B et al (2013) Phase III randomized trial comparing the efficacy of cediranib as monotherapy, and in combination with lomustine, versus lomustine alone in patients with recurrent glioblastoma. J Clin Oncol 31:3212–3218

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. de Groot JF, Lamborn KR, Chang SM et al (2011) Phase II study of aflibercept in recurrent malignant glioma: a North American brain tumor consortium study. J Clin Oncol 29:2689–2695

    Article  PubMed Central  PubMed  Google Scholar 

  48. Prados MD, Yung WK, Jaeckle KA et al (2004) Phase 1 trial of irinotecan (CPT-11) in patients with recurrent malignant glioma: a North American brain tumor consortium study. Neuro Oncol 6:44–54

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Krishnan S, Brown PD, Ballman KV et al (2006) Phase I trial of erlotinib with radiation therapy in patients with glioblastoma multiforme: results of North central cancer treatment group protocol N0177. Int J Radiat Oncol Biol Phys 65:1192–1199

    Article  CAS  PubMed  Google Scholar 

  50. Rich JN, Reardon DA, Peery T et al (2004) Phase II trial of gefitinib in recurrent glioblastoma. J Clin Oncol 22:133–142

    Article  CAS  PubMed  Google Scholar 

  51. van den Bent MJ, Brandes AA, Rampling R et al (2009) Randomized phase II trial of erlotinib versus temozolomide or carmustine in recurrent glioblastoma: EORTC brain tumor group study 26034. J Clin Oncol 27:1268–1274

    Article  PubMed Central  PubMed  Google Scholar 

  52. Eisenstat DD, Nabors LB, Mason WP et al (2011) A phase II study of daily afatinib (BIBW 2992) with or without temozolomide (21/28 days) in the treatment of patients with recurrent glioblastoma. J Clin Oncol (Meeting Abstracts):29(15_suppl 2010)

    Google Scholar 

  53. Chang SM, Wen P, Cloughesy T et al (2005) Phase II study of CCI-779 in patients with recurrent glioblastoma multiforme. Invest New Drugs 23:357–361

    Article  CAS  PubMed  Google Scholar 

  54. Cloughesy TF, Wen PY, Robins HI et al (2006) Phase II trial of tipifarnib in patients with recurrent malignant glioma either receiving or not receiving enzyme-inducing antiepileptic drugs: a North American brain tumor consortium study. J Clin Oncol 24:3651–3656

    Article  CAS  PubMed  Google Scholar 

  55. Doherty L, Gigas DC, Kesari S et al (2006) Pilot study of the combination of EGFR and mTOR inhibitors in recurrent malignant gliomas. Neurology 67:156–158

    Article  CAS  PubMed  Google Scholar 

  56. Galanis E, Buckner JC, Maurer MJ et al (2005) Phase II trial of temsirolimus (CCI-779) in recurrent glioblastoma multiforme: a North central cancer treatment group study. J Clin Oncol 23:5294–5304

    Article  CAS  PubMed  Google Scholar 

  57. Reardon DA, Desjardins A, Vredenburgh JJ et al (2010) Phase 2 trial of erlotinib plus sirolimus in adults with recurrent glioblastoma. J Neurooncol 96:219–230

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Correspondence to Manmeet S. Ahluwalia .

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Venur, V.A., Peereboom, D.M., Ahluwalia, M.S. (2015). Current Medical Treatment of Glioblastoma. In: Raizer, J., Parsa, A. (eds) Current Understanding and Treatment of Gliomas. Cancer Treatment and Research, vol 163. Springer, Cham. https://doi.org/10.1007/978-3-319-12048-5_7

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  • DOI: https://doi.org/10.1007/978-3-319-12048-5_7

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