Biweekly fotemustine schedule for recurrent glioblastoma in the elderly: activity and toxicity assessment of a multicenter study

Addeo, Raffaele; Simonetti, G.; Iodice, Paolo; Marinelli, Alfredo; Montella, Liliana; Cappabianca, Salvatore; Gaviani, Paola; Caraglia, Michele; Prete, Salvatore Del; Silvani, Antonio

doi:10.2217/cns-2019-0004

Cited by 5 publications

(7 citation statements)

References 54 publications

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“…Several studies[ 1 , 19 , 33 ] have reported that FTM is a valuable therapeutic option for elderly patients with rGBM. Paccapelo et al .…”

Section: Discussionmentioning

confidence: 99%

“…Addeo et al [1] Original 2019 58 >65 Chemotherapy with fotemustine is effective and safe treatment 7.…”

Section: No Of Casesmentioning

confidence: 99%

“…Santoni et al [33] Original 2013 65 >65 FTM is a valuable treatment option in elderly rGBM cases KPS: Kernofsky performance status, NA: Not available, FTM: Fotemustine, BEV: Bevacizumab which improves survival and also the overall effect of adjuvant therapy. Resurgery should be considered when (1) patient is in good functional status, (2) the procedure can reduce the raised intracranial pressure, (3) it can reasonably improve the quality of life of the patients, (4) it did not causes significant new neurological deficit or morbidity, (5) when it is possible to resect the contrast enhancing tumor tissue, and (6) the disease is focal and not involving eloquent brain regions, deep structures, or both hemispheres. [32] Several previous studies had reported improved post recurrence survival of at least 7 months for patients who underwent resurgery at GBM recurrence in elderly.…”

Section: No Of Casesmentioning

confidence: 99%

“…On reviewing the literature, patients treated with chemotherapy had better median PPS (21 weeks, 95% CI 8.8-33.2) as compare to patients treated with local treatment (14 weeks, 95% CI 0.9-46.7) P = 0.88. [34] Several studies [1,19,33] have reported that FTM is a valuable therapeutic option for elderly patients with rGBM. Paccapelo et al [28] and Perry et al [31] had compared the FTM with TMZ rechallenge in elderly rGBM cases and reported that TMZ seemed to be active in early and late progression while FTM was always active in recurrent cases.…”

Section: Chemotherapy Versus Local Treatmentmentioning

confidence: 99%

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Recurrent glioblastoma in elderly: Options and decision for the treatment

Prajapati

Singh

2022

Surgical Neurology International

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Background: Glioblastoma (GBM) is the most common primary malignant brain tumor in adult. Its incidence increases with age and nearly half of the all newly diagnosed GBM cases are older than 65 years. Management of GBM in elderly is challenging and recurrence poses further challenge. This article aims to review the literature, evaluate the various options, and to decide the treatment plan in elderly cases with GBM recurrence. Methods: A systemic search was performed with the phrase “recurrent GBM (rGBM) in elderly and management” as a search term in PubMed central, Medline, and Embase databases to identify all the articles published on the subject till February 2022. The review included peer-reviewed original articles, review articles, clinical trials, and keywords in title and abstract. Results: Out of 473 articles searched, 15 studies followed our inclusion criteria and were included in this review. In 15 studies, ten were original and five were review articles. The minimum age group included in these studies was ≥65 years. Out of 15 studies, eight studies had described the role of resurgery, four chemotherapy, three resurgery and/or chemotherapy, and only one study on role of reradiotherapy in patients with rGBM. Out of eight studies described the role of resurgery, six have mentioned improved survival and two have no survival advantage of resurgery in cases of rGBM. Conclusion: Resurgery is the main treatment option in selected elderly rGBM cases in good performance status. In patients with poor performance status, chemotherapy has better post progression survival than best supportive care.

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“…Several studies[ 1 , 19 , 33 ] have reported that FTM is a valuable therapeutic option for elderly patients with rGBM. Paccapelo et al .…”

Section: Discussionmentioning

confidence: 99%

“…Addeo et al [1] Original 2019 58 >65 Chemotherapy with fotemustine is effective and safe treatment 7.…”

Section: No Of Casesmentioning

confidence: 99%

Section: No Of Casesmentioning

confidence: 99%

Section: Chemotherapy Versus Local Treatmentmentioning

confidence: 99%

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Recurrent glioblastoma in elderly: Options and decision for the treatment

Prajapati

Singh

2022

Surgical Neurology International

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“… 26 Procarbazine was found to be less effective than temozolomide in a randomized trial. 22 Fotemustine, a third-generation intravenous nitrosourea with lower rates of thrombocytopenia, 27 , 28 is used in several countries at different schedules.…”

Section: Currently Approved Treatments For Recurrent Glioblastomamentioning

confidence: 99%

Recurrent Glioblastoma: Ongoing Clinical Challenges and Future Prospects

Pineda¹,

Doménech²,

Hernández³

et al. 2023

OTT

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Virtually all glioblastomas treated in the first-line setting will recur in a short period of time, and the search for alternative effective treatments has so far been unsuccessful. Various obstacles remain unresolved, and no effective salvage therapy for recurrent glioblastoma can be envisaged in the short term. One of the main impediments to progress is the low incidence of the disease itself in comparison with other pathologies, which will be made even lower by the recent WHO classification of gliomas, which includes molecular alterations. This new classification helps refine patient prognosis but does not clarify the most appropriate treatment. Other impediments are related to clinical trials: glioblastoma patients are often excluded from trials due to their advanced age and limiting neurological symptoms; there is also the question of how best to measure treatment efficacy, which conditions the design of trials and can affect the acceptance of results by oncologists and medicine agencies. Other obstacles are related to the drugs themselves: most treatments cannot cross the blood-brain-barrier or the brain-to-tumor barrier to reach therapeutic drug levels in the tumor without producing toxicity; the drugs under study may have adverse metabolic interactions with those required for symptom control; identifying the target of the drug can be a complex issue. Additionally, the optimal method of treatment – local vs systemic therapy, the choice of chemotherapy, irradiation, targeted therapy, immunotherapy, or a combination thereof – is not yet clear in glioblastoma in comparison with other cancers. Finally, in addition to curing or stabilizing the disease, glioblastoma therapy should aim at maintaining the neurological status of the patients to enable them to return to their previous lifestyle. Here we review currently available treatments, obstacles in the search for new treatments, and novel lines of research that show promise for the future.

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