Recent therapeutic advances and insights of recurrent glioblastoma multiforme 

Abstract

Despite recent therapeutic advances, most patients with glioblastoma multiforme (GBM) experience disease recurrence, with very poor prognosis. Much work still needs to done to improve the treatment efficacy. The optimal management of patients with recurrent GBM is still controversial. This article summarizes the current status of therapeutic strategies in recurrent glioblastoma patients, with an emphasis on more novel approaches and important recent progress. The clinical evidence of current treatment strategies were collected and reviewed. Patients still need comprehensive treatment for recurrent GBM. Surgery may be useful as adjuvant treatment for patients with symptoms due to the effect of the mass or for patients requiring definitive histopathology, but it generally should be combined with another treatment modality; high-precision re-irradiation such as stereotactic radiosurgery or gamma knife is another option. Chemotherapy like fotemustine, or a metronomic schedule of temozolomide regimens and anti-angiogenic agents like bevacizumab could also be considered. Other targeted molecular inhibitors or anti-angiogenic therapies, and immunotherapies are still under investigation and their efficacy needs to be evaluated further in the future.

Salvage therapy for recurrent glioblastoma multiforme: a multimodal approach combining fluorescence-guided resurgery, interstitial irradiation, and chemotherapy

“…29 Other studies on different new chemotherapeutic agents report a range of survival, from 6 to 26 months. 6,14,17,21 Bevacizumab is an attractive drug for chemotherapeutical treatment because gioblastomas are highly vascular and express high levels of vascular endothelial growth factor. Several reports and a phase II trial of bevacizumab plus irinotecan have demonstrated encouraging response rates.…”

“…2,12,13 Various chemotherapeutic modalities are employed for recurrent gliomas ranging from a metronomic schedule of temozolomide as dense dose treatment modality to other forms of chemotherapy such as fotemustine, or anti-angiogenic agents such as bevacizumab. 14 In recurrent GBM, temozolomide compared with standard chemotherapy improves time-to-progression and may have benefits on quality of life without increasing adverse events. 15 Improved outcomes with the application of a multimodality management of patients with recurrent malignant glioma have been reported in several series, 16 yet no standardized treatment algorithm exists that approaches this challenging pathological entity in a systematic, logical, and concise manner.…”

Casein Kinase 2: A Novel Player in Glioblastoma Therapy and Cancer Stem Cells

“…GBM is most common in the sixth and seventh decade of life, and more commonly occurs in men than women. All patients with GBM universally experience disease recurrence (Chen and Xu, 2013). Currently, the standard treatment approaches for patients with GBM include safe optimal surgical resection, followed by radiotherapy, and chemotherapy (Ahmadloo et al, 2013).…”

Mecanismos de reparo de DNA envolvidos com lesões induzidas por agente alquilante (Nimustina) em células humanas e sua associação com a resistência de gliomas.

“…Atualmente, a droga de escolha é a temozolomida (TMZ) (CHEN et al, 2012;XU, 2013; STUPP; VAN DEN BENT;HEGI, 2005;RECHT;NAGPAL, 2013). (Por serem as principais drogas utilizadas na clínica e pelo tipo de lesão que induzem no DNA, ACNU e TMZ foram eleitas as drogas de estudo deste trabalho e serão melhor discutidas posteriormente).…”

“…São usualmente administradas concomitantemente com a RT e, após o encerramento desta, por outros 6 meses em ciclos de 5 por 28 dias (ZHANG et al, 2012). As nitrosouréias ACNU (nimustina), BCNU (carmustina) e CCNU (lomustina) são conhecidas como CENUs e foram, durante um longo tempo, as drogas comumente usadas como primeira linha no tratamento de GBMs (WELLER et al, 2012).Atualmente, a droga de escolha é a temozolomida (TMZ) (CHEN et al, 2012;XU, 2013; STUPP; VAN DEN BENT;HEGI, 2005;RECHT;NAGPAL, 2013). (Por serem as principais drogas utilizadas na clínica e pelo tipo de lesão que induzem no DNA, ACNU e TMZ foram eleitas as drogas de estudo deste trabalho e serão melhor discutidas posteriormente).…”