SYSTEMIC THERAPY IN PATIENTS WITH RELAPSED GLIOBLASTOMA: For patients with relapsed GBM there is currently no standard systemic therapy.
Temozolomide rechallenge: Wick et al. treated 64 patients with TMZ 150 mg/m(2), one week on, one week off and observed PFS-6 of 43.8%, and OAS of 8.4 months after the diagnosis of relapse. Strik et al. reported on 13 patients treated 5 days in a week and observed a PFS-6 of 39%, OAS of 7.8 months, Perry et al. reported on 50 mg/m(2).
Bevacizumab: Vredenburgh et al. reported prospectively rapid symptomatic relief, PFS-6 of 46% and OAS of 8 months in 35 patients with relapsed GBM. The BRAIN study evaluated 167 patients with Avastin/Irinotecan vs. Avastin alone in patients with relapsed GBM, showing PFS-6 of 50 vs. 42% and OAS of 8.7 vs. 9.2 months.
Experimental treatment: More than 40 drugs are currently investigated in patients with relapsed gliomas.
Best supportive care: Should be part of all interactions with a neuro-oncologist.
Conclusions: Thorough consideration of the individual patient's characteristics to evaluate the best fitted treatment is warranted, preferentially in the context of an interdisciplinary tumour board.