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.
Management of glioblastoma: State of the art and future directions
Aaron C Tan 1, David M Ashley 2, Giselle Y López 2 3, Michael Malinzak 2 4, Henry S Friedman 2, Mustafa Khasraw 2Affiliations expand
- PMID: 32478924
- DOI: 10.3322/caac.21613
Free article
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.
Keywords: chemotherapy; glioblastoma; immunotherapy; radiotherapy; surgery; targeted therapy.
© 2020 American Cancer Society.
Similar articles
- Molecular Evolution of IDH Wild-Type Glioblastomas Treated With Standard of Care Affects Survival and Design of Precision Medicine Trials: A Report From the EORTC 1542 Study.Draaisma K, Chatzipli A, Taphoorn M, Kerkhof M, Weyerbrock A, Sanson M, Hoeben A, Lukacova S, Lombardi G, Leenstra S, Hanse M, Fleischeuer R, Watts C, McAbee J, Angelopoulos N, Gorlia T, Golfinopoulos V, Kros JM, Verhaak RGW, Bours V, van den Bent MJ, McDermott U, Robe PA, French PJ.J Clin Oncol. 2020 Jan 1;38(1):81-99. doi: 10.1200/JCO.19.00367. Epub 2019 Nov 19.PMID: 31743054
- Treatment of Glioblastoma.Nam JY, de Groot JF.J Oncol Pract. 2017 Oct;13(10):629-638. doi: 10.1200/JOP.2017.025536.PMID: 29020535 Review.
- N2M2 (NOA-20) phase I/II trial of molecularly matched targeted therapies plus radiotherapy in patients with newly diagnosed non-MGMT hypermethylated glioblastoma.Wick W, Dettmer S, Berberich A, Kessler T, Karapanagiotou-Schenkel I, Wick A, Winkler F, Pfaff E, Brors B, Debus J, Unterberg A, Bendszus M, Herold-Mende C, Eisenmenger A, von Deimling A, Jones DTW, Pfister SM, Sahm F, Platten M.Neuro Oncol. 2019 Jan 1;21(1):95-105. doi: 10.1093/neuonc/noy161.PMID: 30277538 Free PMC article. Clinical Trial.
- The Evolving Role of Tumor Treating Fields in Managing Glioblastoma: Guide for Oncologists.Burri SH, Gondi V, Brown PD, Mehta MP.Am J Clin Oncol. 2018 Feb;41(2):191-196. doi: 10.1097/COC.0000000000000395.PMID: 28832384 Free PMC article. Review.
- Postoperative neoadjuvant temozolomide before radiotherapy versus standard radiotherapy in patients 60 years or younger with anaplastic astrocytoma or glioblastoma: a randomized trial.Malmström A, Poulsen HS, Grønberg BH, Stragliotto G, Hansen S, Asklund T, Holmlund B, ?ysiak M, Dowsett J, Kristensen BW, Söderkvist P, Rosell J, Henriksson R; Nordic Clinical Brain Tumor Study Group (NCBTSG).Acta Oncol. 2017 Dec;56(12):1776-1785. doi: 10.1080/0284186X.2017.1332780. Epub 2017 Jul 4.PMID: 28675067 Clinical Trial.
Cited by 41 articles
- miR-1258 Attenuates Tumorigenesis Through Targeting E2F1 to Inhibit PCNA and MMP2 Transcription in Glioblastoma.Qin H, Gui Y, Ma R, Zhang H, Guo Y, Ye Y, Li J, Zhao L, Wang Y.Front Oncol. 2021 May 17;11:671144. doi: 10.3389/fonc.2021.671144. eCollection 2021.PMID: 34079762 Free PMC article.
- Dynein Light Chain Protein Tctex1: A Novel Prognostic Marker and Molecular Mediator in Glioblastoma.Dumitru CA, Brouwer E, Stelzer T, Nocerino S, Rading S, Wilkens L, Sandalcioglu IE, Karsak M.Cancers (Basel). 2021 May 27;13(11):2624. doi: 10.3390/cancers13112624.PMID: 34071761 Free PMC article.
- Oncogenesis, Microenvironment Modulation and Clinical Potentiality of FAP in Glioblastoma: Lessons Learned from Other Solid Tumors.Shi Y, Kong Z, Liu P, Hou G, Wu J, Ma W, Cheng X, Wang Y.Cells. 2021 May 10;10(5):1142. doi: 10.3390/cells10051142.PMID: 34068501 Free PMC article. Review.
- Viral Gene Therapy for Glioblastoma Multiforme: A Promising Hope for the Current Dilemma.Li J, Wang W, Wang J, Cao Y, Wang S, Zhao J.Front Oncol. 2021 May 13;11:678226. doi: 10.3389/fonc.2021.678226. eCollection 2021.PMID: 34055646 Free PMC article. Review.
- Overexpressed XRCC2 as an independent risk factor for poor prognosis in glioma patients.Liu Z, Zhang W, Cheng X, Wang H, Bian L, Wang J, Han Z, Wang Y, Lian X, Liu B, Ren Z, Zhang B, Jiang Z, Lin Z, Gao Y.Mol Med. 2021 May 29;27(1):52. doi: 10.1186/s10020-021-00316-0.PMID: 34051735 Free PMC article.
References
- Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011-2015. Neuro Oncol. 2018;20(suppl 4):iv1-iv86.
