Summary and Further Reading

Chapter 4 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

Summary

  • Clinical decision-making should be based on a histologically verified diagnosis
  • Molecular markers (IDH, 1p/19q, MGMT, EGFR status) assume increasing importance for diagnostic and therapeutic concepts
  • Gross total resection is associated with improved outcome
  • Partial resections may not improve outcome over biopsy alone
  • Involved-field RT, e.g. 60 Gy in 1.8–2 Gy fractions, doubles survival, but is not curative
  • The alkylating agent TMZ prolongs progression-free and overall survival when combined with RT
  • The benefit from TMZ added to RT in patients with IDH wildtype anaplastic glioma and glioblastoma is probably limited to patients with MGMT promoter Methylation
  • Bevacizumab prolongs progression-free, but not overall, survival in newly diagnosed glioblastoma
  • Bevacizumab has clinical value as a salvage treatment in recurrent anaplastic astrocytoma and glioblastoma
  • EGFRvIII-targeted vaccination, DC vaccination and electrical tumour-treating fields are emerging treatment approaches

Further Reading

Chinot OL, Wick W, Mason W, et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med 2014; 370:709–722.

Gilbert MR, Dignam JJ, Armstrong TS, et al. A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med 2014; 370:699–708.

Hegi ME, Stupp R. Withholding temozolomide in glioblastoma patients with unmethylated MGMT promoter – still a dilemma? Neuro Oncol 2015; 17:1425–1427.

Prados MD, Byron SA, Tran NL, et al. Toward precision medicine in glioblastoma: the promise and the challenges. Neuro Oncol 2015; 17:1051–1063.

Stupp R, Taillibert S, Kanner AA, et al. Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: a randomized clinical trial. JAMA 2015; 314:2535–2543.

Weller M, Tabatabai G, Kästner B, et al; DIRECTOR Study Group. MGMT promoter methylation is a strong prognostic biomarker for benefit from dose-intensified temozolomide rechallenge in progressive glioblastoma: the DIRECTOR trial. Clin Cancer Res 2015; 21:2057–2064.

Weller M, van den Bent M, Hopkins K, et al; European Association for Neuro-Oncology (EANO) Task Force on Malignant Glioma. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014; 15:e395–e403.

Weller M, Wick W, Aldape K, et al. Glioma. Nat Rev Dis Primers 2015; 1:15017.

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Last update: 18 September 2017