Management of glioblastoma: State of the art and future directions

Abstract

Glioblastoma is the most common malignant primary brain tumor. Overall, the prognosis for patients with this disease is poor, with a median survival of <2 years. There is a slight predominance in males, and incidence increases with age. The standard approach to therapy in the newly diagnosed setting includes surgery followed by concurrent radiotherapy with temozolomide and further adjuvant temozolomide. Tumor-treating fields, delivering low-intensity alternating electric fields, can also be given concurrently with adjuvant temozolomide. At recurrence, there is no standard of care; however, surgery, radiotherapy, and systemic therapy with chemotherapy or bevacizumab are all potential options, depending on the patient's circumstances. Supportive and palliative care remain important considerations throughout the disease course in the multimodality approach to management. The recently revised classification of glioblastoma based on molecular profiling, notably isocitrate dehydrogenase (IDH) mutation status, is a result of enhanced understanding of the underlying pathogenesis of disease. There is a clear need for better therapeutic options, and there have been substantial efforts exploring immunotherapy and precision oncology approaches. In contrast to other solid tumors, however, biological factors, such as the blood-brain barrier and the unique tumor and immune microenvironment, represent significant challenges in the development of novel therapies. Innovative clinical trial designs with biomarker-enrichment strategies are needed to ultimately improve the outcome of patients with glioblastoma.

Prognostic Factors and Diseases-Specific Survival Outcome in Patients with Glioblastoma: A Population-Based Study

“…Extensive efforts are needed to explore new treatments in areas such as immunotherapy and precision oncology. However, compared with other solid tumors, biological factors such as the blood-brain barrier, unique tumors and immune microenvironment pose major challenges in developing new therapies [20].…”

Radiation Effects on Brain Extracellular Matrix

“…Adjuvant chemoradiotherapy with temozolomide is a conventional protocol for the standard treatment for newly diagnosed glioblastoma multiforme (GBM) ( 1 ). Last decades, new treatment approaches have shown promise in improving GBM outcomes and are described in details in the reviews ( 2 , 3 ).…”

Ocular Side Effects of EGFR-Inhibitor ABT-414 in Recurrent Glioblastoma: A Long-Term Safety Study

“…Glioblastoma (GBM) is the most common primary malignant tumor of the central nervous system in adults, accounting for almost 50% of all malignant primary tumors of the brain, with a 5-years overall survival of 5% ( 1 ). Approximately 50% of GBMs harbor epidermal growth factor receptor (EGFR) gene amplification, causing the consequent overexpression of the EGFR protein ( 2 , 3 ).…”

“…EGFR-inhibitors are commonly used in the treatment of different EGFR amplified cancers, including colorectal, lung, breast, pancreatic, renal, head and neck, gynecologic, prostate and central nervous system tumors ( 2 – 6 ). These drugs have been proved to improve the prognosis of patients affected these tumors, suggesting a possible use in patients affected by EGFR amplified GBM ( 1 – 6 ).…”