Treatment Options in Newly Diagnosed Glioblastoma
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Regardless of MGMT status, standard of care for a patient with newly diagnosed glioblastoma (GBM), age ≤70 years, and adequate functional status is radiation and concurrent temozolomide followed by adjuvant temozolomide. For elderly patients, recent studies have suggested that standard radiation, hypofractionated radiation, or single agent temozolomide are acceptable treatment options. Randomized phase III studies of bevacizumab in combination with radiation and temozolomide for newly diagnosed GBM have completed accrual. Preliminary results reveal a clear progression-free survival benefit. Overall survival appears unchanged although follow-up has not fully matured and cross-over to bevacizumab upon progression among control patients may limit definitive conclusions. Although bevacizumab in the upfront setting may be considered for a subset of patients, it should not be used routinely in newly diagnosed patients until final results are available. Clinical trials evaluating promising therapeutics given in combination with standard temozolomide chemoradiation are critically needed.
KeywordsGlioblastoma Temozolomide Radiation Bevacizumab Treatment Newly diagnosed Carmustine polymer wafers
Conflict of Interest
Eudocia Q. Lee has served on an advisory board for Novartis and has been paid for manuscript preparation by Up To Date and Continuum.
Lakshmi Nayak has served as a consultant for Genentech and Novartis.
Patrick Y. Wen has served as a consultant for Amgen, AstraZeneca, Exelixis, Eisai Co., Genentech, Merck & Co., Novartis, MedImmune, Sanofi-Aventis, and Vascular Biogenics.
David A. Reardon has served as a consultant and received honoraria from Abbott Laboratories, Abgenix, EMD Serono, Genentech/Roche, Merck/Schering, and Novartis.
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