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Management of malignant glioma: steady progress with multimodal approaches
Lynn S Ashby1, Timothy C Ryken
1Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Abstract:
Despite recent successes in the treatment of cancer with multidisciplinary multimodal treatment approaches, the duration of survival for patients with malignant glioma remains limited. Malignant gliomas represent a class of infiltrative, aggressive neoplasms that are generally resistant to combination therapies. The basic approach to treatment has involved a combination of surgery and radiotherapy. The use of chemotherapy has been met with skepticism because of its limited efficacy and the significant side effects demonstrated in clinical trials. Nevertheless, based on findings in randomized trials of new agents, it has been suggested that further evaluation of the role of chemotherapy is warranted. Temozolomide and Gliadel (carmustine wafers) are generally well tolerated due to their limited systemic toxicity. These agents appear particularly well suited for incorporation into multimodal treatment strategies. Proposed investigations and ongoing clinical trials will be conducted to assess the use of these agents in novel combination therapies. Future treatment strategies may include a wide variety of biological response modifiers, but will need to continue to address local control with surgery, radiation, and adjuvant chemotherapy.
Insights
Malignant gliomas have limited survival despite multimodal treatments. New chemotherapy agents like temozolomide and carmustine wafers show promise for improving outcomes in combination therapies.
Area of Science:
- Neuro-oncology
- Cancer Therapeutics
- Clinical Trials
Background:
- Malignant gliomas are aggressive, infiltrative brain tumors with limited survival rates.
- Current treatments (surgery, radiotherapy) are insufficient, and chemotherapy has faced skepticism due to efficacy and side effects.
Purpose of the Study:
- To evaluate the role of chemotherapy in multimodal treatment strategies for malignant gliomas.
- To explore the potential of novel chemotherapy agents in combination therapies.
Main Methods:
- Review of findings from randomized trials of new chemotherapy agents.
- Focus on agents with limited systemic toxicity, such as temozolomide and carmustine wafers.
- Discussion of proposed investigations and ongoing clinical trials.
Main Results:
- Temozolomide and carmustine wafers demonstrate good tolerability and limited systemic toxicity.
- These agents are suitable for integration into multimodal treatment approaches.
Conclusions:
- Further evaluation of chemotherapy, particularly temozolomide and carmustine wafers, is warranted for malignant gliomas.
- Future strategies will likely involve novel combinations of surgery, radiation, chemotherapy, and biological response modifiers.
