Multimodal treatment for local recurrent malignant gliomas: Resurgery and/or reirradiation followed by chemotherapy

• Published in: Molecular and clinical oncology Vol. 10; no. 1; pp. 49 - 57
• Main Authors: Prelaj, Arsela, Rebuzzi, Sara Elena, Grassi, Massimiliano, Giròn Berrìos, Julio Rodrigo, Pecorari, Silvia, Fusto, Carmela, Ferrara, Carla, Salvati, Maurizio, Stati, Valeria, Tomao, Silverio, Bianco, Vincenzo
• Format: Journal Article
• Language: English
• Published: England Spandidos Publications 01.01.2019; Spandidos Publications UK Ltd; D.A. Spandidos
• Subjects: Brain cancer; Care and treatment; Chemotherapy; Clinical trials; Dehydrogenases; Disease control; Glioma; Gliomas; Immunotherapy; Monoclonal antibodies; NMR; Nuclear magnetic resonance; Oncology; Radiation therapy; Radiotherapy; Response rates; Safety and security measures; Surgery; Survival analysis; Targeted cancer therapy; fotemustine; recurrent glioblastomas; bevacizumab; radiotherapy; multimodal; chemotherapy; recurrent malignant gliomas; surgery
• ISSN: 2049-9450; 2049-9469
• DOI: 10.3892/mco.2018.1745

The therapeutic management of recurrent malignant gliomas (MGs) is not determined. Therefore, the efficacy of a multimodal approach and a combination systemic therapy was investigated. A retrospective analysis of 26 MGs patients at first relapse treated with multimodal therapy (chemotherapy plus surgery and/or reirradiation) or chemotherapy alone was performed. Second-line chemotherapy consisted of fotemustine (FTM) in combination with bevacizumab (BEV) (cFTM/BEV) or followed by third-line BEV (sFTM/BEV). Subgroup analyses were performed. Multimodal therapy provided a higher overall response rate (ORR) (73 vs. 47%), disease control rate (DCR) (82 vs. 67%), median progression-free survival (mPFS) (11 vs. 7 months; P=0.08) and median overall survival (mOS) (13 vs. 8 months; P=0.04) compared with chemotherapy. Concomitant FTM/BEV resulted in higher ORR (84 vs. 36%), DCR (92 vs. 57%), mPFS (10 vs. 5 months; P=0.22) and mOS (11 vs. 5.2 months; P=0.15) compared with sFTM/BEV. Methylated patients did not experience additional survival benefits with multimodality treatment but had higher mPFS (10 vs 7.1 months; P=0.33) and mOS (11 vs. 8 months; P=0.33) with cFTM/BEV. Unmethylated patients experienced the greatest survival benefit with the multimodal approach (mPFS: 10 vs. 5 months; mOS 11 vs 6 months; both P=0.02) and cFTM/BEV (mPFS: 5 vs. 2 months; mOS 6 vs. 3.2 months; both P=0.01). In conclusion, in recurrent MGs, multimodal therapy and cFTM/BEV provide survival and response benefits. Methylated patients benefit from a cFTM/BEV but not from a multimodal approach. Notably, unmethylated patients had the highest survival benefit with the two strategies.