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Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes

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Abstract

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

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Acknowledgments

TH, LP received honaria for advisory board lecture and travel grants from Roche and MSD. PR received honoraria for advisory board activities or lectures from MSD, Roche, Novartis and Molecular Partners. MW has received research grants from Acceleron, Actelion, Alpinia Institute, Bayer, Isarna, MSD, Merck & Co, Novocure, PIQUR and Roche and honoraria for lectures or advisory board participation or consulting from Celldex, Immunocellular, Isarna, Magforce, MSD, Merck & Co, Northwest Biotherapeutics, Novocure, Pfizer, Roche and Teva.

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Correspondence to T. Hundsberger.

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AFH, UR, DM, PYD, KC, EH, AP, MWG, DB disclosed no conflict of interest.

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No specific patient data was used in this project.

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The Department of Radiation Oncology (PMP) at the Cantonal hospital St. Gallen received a grant from Roche, Switzerland to perform this analysis.

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On behalf of the Swiss Group for Clinical Cancer Research (SAKK) Central Nervous System working group.

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Hundsberger, T., Hottinger, A.F., Roelcke, U. et al. Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes. J Neurooncol 126, 175–183 (2016). https://doi.org/10.1007/s11060-015-1957-0

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