Management of glioblastoma: State of the art and future directions

• Published in: CA: a cancer journal for clinicians Vol. 70; no. 4; pp. 299 - 312
• Main Authors: Tan, Aaron C., Ashley, David M., López, Giselle Y., Malinzak, Michael, Friedman, Henry S., Khasraw, Mustafa
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2020
• Subjects: Antineoplastic Agents - therapeutic use; Bevacizumab; Bevacizumab - therapeutic use; Blood-brain barrier; Brain - diagnostic imaging; Brain - pathology; Brain - surgery; Brain cancer; Brain Neoplasms - genetics; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - therapy; Brain tumors; Chemoradiotherapy, Adjuvant - methods; Chemotherapy; Electric fields; Glioblastoma; Glioblastoma - genetics; Glioblastoma - mortality; Glioblastoma - pathology; Glioblastoma - therapy; Humans; Immunotherapy; Immunotherapy - methods; Incidence; Isocitrate dehydrogenase; Isocitrate Dehydrogenase - genetics; Magnetic Field Therapy - methods; Magnetic Resonance Imaging; Medical prognosis; Monoclonal antibodies; Mutation; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Oncology; Patients; Precision medicine; Precision Medicine - methods; Prognosis; Radiation therapy; radiotherapy; Review Literature as Topic; Solid tumors; Surgery; Survival Rate; Targeted cancer therapy; targeted therapy; Temozolomide; Temozolomide - therapeutic use; Treatment Outcome; Tumor Microenvironment; United States - epidemiology; United States; radiotherapy; targeted therapy; glioblastoma; chemotherapy; immunotherapy; surgery
• ISSN: 0007-9235; 1542-4863
• DOI: 10.3322/caac.21613

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.