Malignant glioma: Viewpoint—chemotherapy

Roger Stupp Stupp; Krisztian Homicsko; J. Gregory Cairncross

doi:10.1007/978-1-4614-8363-2_19

Malignant glioma: Viewpoint—chemotherapy

Roger Stupp Stupp^*, Krisztian Homicsko, J. Gregory Cairncross

^*Corresponding author for this work

Neurological Surgery

Research output: Chapter in Book/Report/Conference proceeding › Chapter

Abstract

Malignant gliomas are diffusely infiltrating and thus any local treatment has its inherent limitations. Alkylating agent chemotherapy has repeatedly demonstrated improvement in disease-free and overall survival. Concomitant chemoradiotherapy with temozolomide is the standard of care in glioblastoma, neoadjuvant or adjuvant chemotherapy with PCV improves survival in anaplastic oligodendroglial tumors with a 1p/19q co-deletion, however the benefit is only seen with long follow-up of>6 years. Randomized trials in anaplastic glioma have shown that the treatment sequence, radiotherapy first and chemotherapy at recurrence or the reverse, does not matter in terms of progression-free or overall survival. MGMT gene promoter methylation is the single strongest predictive factor for benefit from chemotherapy in grade IV tumors, and is an important prognostic marker in grade III tumors. In elderly patients, treatment with TMZ was beneficial for tumors with a methylated MGMT, and superior to radiotherapy alone, while patients with an unmethylated MGMT should not be treated with TMZ but rather with RT. Novel agents are under investigation for patients with recurrent disease. Although VEGF pathway inhibition failed to prolong overall survival, treatment with the monoclonal antibody bevacizumab may improve quality of life of selected patients with recurrent glioma.

Original language	English (US)
Title of host publication	Principles and Practice of Stereotactic Radiosurgery
Publisher	Springer New York
Pages	279-293
Number of pages	15
ISBN (Electronic)	9781461483632
ISBN (Print)	9781461483625
DOIs	https://doi.org/10.1007/978-1-4614-8363-2_19
State	Published - Jan 1 2015

Funding

The authors are grateful to the National Institute of Education/Nanyang Technological University, Singapore, for providing the AcRF grant RP 3/06/RSR. One of us (R.V.) would like to thank NIE/NTU for providing the research scholarship and parent organization Institute for Plasma Research, Gandhinagar, Gujarat, India for providing study leave to pursue Ph.d. Programme.

ASJC Scopus subject areas

General Medicine

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10.1007/978-1-4614-8363-2_19

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title = "Malignant glioma: Viewpoint—chemotherapy",

abstract = "Malignant gliomas are diffusely infiltrating and thus any local treatment has its inherent limitations. Alkylating agent chemotherapy has repeatedly demonstrated improvement in disease-free and overall survival. Concomitant chemoradiotherapy with temozolomide is the standard of care in glioblastoma, neoadjuvant or adjuvant chemotherapy with PCV improves survival in anaplastic oligodendroglial tumors with a 1p/19q co-deletion, however the benefit is only seen with long follow-up of>6 years. Randomized trials in anaplastic glioma have shown that the treatment sequence, radiotherapy first and chemotherapy at recurrence or the reverse, does not matter in terms of progression-free or overall survival. MGMT gene promoter methylation is the single strongest predictive factor for benefit from chemotherapy in grade IV tumors, and is an important prognostic marker in grade III tumors. In elderly patients, treatment with TMZ was beneficial for tumors with a methylated MGMT, and superior to radiotherapy alone, while patients with an unmethylated MGMT should not be treated with TMZ but rather with RT. Novel agents are under investigation for patients with recurrent disease. Although VEGF pathway inhibition failed to prolong overall survival, treatment with the monoclonal antibody bevacizumab may improve quality of life of selected patients with recurrent glioma.",

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Malignant glioma: Viewpoint—chemotherapy

Abstract

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ASJC Scopus subject areas

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