Long-term survival in a patient with glioblastoma on antipsychotic therapy for schizophrenia: a case report and literature review

Abstract

Glioblastoma is not only the most common primary brain tumor, but also the most aggressive. Currently, the most effective treatment of surgery, chemotherapy and radiation therapy allows for a modest median survival of 15 months. Here, we report a case of a 57-year-old male with histologically confirmed glioblastoma with unfavorable prognostic characteristics (poor performance status and persistent neurological symptoms after surgery), whose expected 5-year survival is 0%. Further genetic analysis offered a mixed prognostic picture with positive methylation of 0-6-methylguinine-DNA (deoxyribonucleic acid) methyltransferase (MGMT; favorable prognosis) and wild-type isocitrate dehydrogenase 1 (IDH-1; unfavorable prognosis). Remarkably, the patient showed a progression-free survival of 5.5 years and a total survival of 6.5 years. In the context of recently published literature, the authors hypothesize that the patient's use of the antipsychotic medication risperidone may have had a potential antitumor effect. Risperidone antagonizes the dopamine-2 receptor and the serotonin-7 receptor, both of which have been individually implicated in the growth and progression of glioblastoma. To the authors' knowledge, this is the first clinical case in the literature to explore this association.

Beyond IDH-Mutation: Emerging Molecular Diagnostic and Prognostic Features in Adult Diffuse Gliomas

“…Within a histologic grade, IV astrocytoma cohorts, akin to lower-grade astrocytomas, a mutation in IDH1 or IDH2 carries the most significant prognostic value [ 4 , 7 ] ( Table 3 ). IDH-mutant GBMs show a median survival of 24–31 months (depending on treatment modalities) in comparison to 9–15 months for their histologically similar wildtype counterparts [ 4 , 7 , 106 , 108 ], although there are reports of much longer survival in some of these cases [ 109 , 110 , 111 , 112 , 113 , 114 , 115 ]. These tumors also occur at a younger age than their IDH-wildtype GBM counterparts (5 th decade compared to 7 th decade, respectively) [ 34 , 52 , 105 , 106 ], and have increased rates of TP53 and ATRX mutation as well as lower rates of TERT p mutation, PTEN mutation, and EGFR amplification [ 107 ].…”

Anticancer Properties of the Antipsychotic Drug Chlorpromazine and Its Synergism With Temozolomide in Restraining Human Glioblastoma Proliferation In Vitro

“…Furthermore, several reports show that CPZ can inhibit cancer cell growth through several mechanisms (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In addition, epidemiological data suggest a reduction of cancer risk in psychiatric patients treated with CPZ or related antipsychotic compounds (16,17), and anecdotal reports of favorable GBM evolution in psychiatric patients treated with neuroleptic medications have been published (16,18).…”

TP3, an antimicrobial peptide, inhibits infiltration and motility of glioblastoma cells via modulating the tumor microenvironment

“…The pathogenicity in most cases remains unclear with less than 3%‐5% of the survival rate after 5 years. Without treatments, most patients can only survive for about 3 months 50,51 . Malaka et al reported that in newly diagnosed glioblastoma patients, the use of anti‐angiogenic therapies did not significantly improve overall survival, 52 indicating that new treatments and drugs are necessary to overcome this issue.…”