The current landscape of systemic therapy for recurrent glioblastoma: A systematic review of randomized-controlled trials

Francesco G T Fazzari; Foster Rose; Mehrnoosh Pauls; Evelyne Guay; Mohammed F K Ibrahim; Bassam Basulaiman; Megan Tu; Brian Hutton; Garth Nicholas; Terry L Ng

doi:10.1016/j.critrevonc.2021.103540

The current landscape of systemic therapy for recurrent glioblastoma: A systematic review of randomized-controlled trials

Crit Rev Oncol Hematol. 2022 Jan:169:103540. doi: 10.1016/j.critrevonc.2021.103540. Epub 2021 Nov 19.

Authors

Affiliations

¹ Faculty of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada.
² BC Cancer Center, University of British Columbia, 600 W 10th Ave, Vancouver, BC V5Z 4E6, Canada.
³ Division of Clinical Sciences, Medical Oncology, Northern Ontario School of Medicine, 955 Oliver Rd, Thunder Bay, ON P7B 5E1, Canada.
⁴ Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Makkah Al Mukarramah Branch Rd, As Sulimaniyah, Riyadh 11564, Saudi Arabia.
⁵ Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
⁶ Clinical Epidemiology Program, The Ottawa Hospital Research Institute and University of Ottawa, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
⁷ Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Division of Medical Oncology, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
⁸ Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Division of Medical Oncology, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: teng@toh.ca.

PMID: 34808376
DOI: 10.1016/j.critrevonc.2021.103540

Abstract

Aim: Conduct a systematic review of the effectiveness of systemic therapies for adult recurrent glioblastoma (rGBM).

Methods: We electronically searched for randomized controlled trials from three major databases and four conferences from 2009-Dec 2020. Two independent reviewers conducted screening, data extraction, and quality assessment.

Results: 48 randomized trials were identified. Outcome reporting was inconsistent: overall survival (OS) in 46 studies, progression free survival in 37 studies, 6-month PFS in 30 studies, objective response rate in 28 studies, and 6-month OS in 7 studies. Network meta-analysis was not feasible due to heterogeneity in outcome reporting and single-study linkages. Most studies compared lomustine (8 studies), bevacizumab (18), or temozolomide (8) with other treatments. The median OS across all studies ranged from 3 to 17.6 months.

Conclusions: Based on level one evidence, there is no superior systemic regimen for rGBM. rGBM is a heterogeneous population with no single regimen demonstrating OS benefit. Registration number: CRD42020148512.

Keywords: Anti-angiogenic; Antibody-drug conjugate; Chemotherapy; Immunotherapy; Recurrent glioblastoma; Systematic review; Systemic therapy.

Publication types

Review
Systematic Review

MeSH terms

Adult
Bevacizumab
Brain Neoplasms* / drug therapy
Glioblastoma* / drug therapy
Humans
Neoplasm Recurrence, Local / drug therapy
Progression-Free Survival
Randomized Controlled Trials as Topic
Temozolomide

Substances

Bevacizumab
Temozolomide