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Published on: October 27, 2014
Neurosurgical Clinical Trials for Glioblastoma: Current and Future Directions
Ashish H Shah1,2, John D Heiss1
1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
Abstract:
The mainstays of glioblastoma treatment, maximal safe resection, radiotherapy preserving neurological function, and temozolomide (TMZ) chemotherapy have not changed for the past 17 years despite significant advances in the understanding of the genetics and molecular biology of glioblastoma. This review highlights the neurosurgical foundation for glioblastoma therapy. Here, we review the neurosurgeon's role in several new and clinically-approved treatments for glioblastoma. We describe delivery techniques such as blood-brain barrier disruption and convection-enhanced delivery (CED) that may be used to deliver therapeutic agents to tumor tissue in higher concentrations than oral or intravenous delivery. We mention pivotal clinical trials of immunotherapy for glioblastoma and explain their outcomes. Finally, we take a glimpse at ongoing clinical trials and promising translational studies to predict ways that new therapies may improve the prognosis of patients with glioblastoma.
Insights
Glioblastoma treatment remains challenging, with neurosurgery playing a key role in novel drug delivery and immunotherapy. Future therapies aim to improve patient prognosis through advanced techniques and clinical trials.
Area of Science:
- Neurosurgery
- Oncology
- Drug Delivery Systems
Background:
- Glioblastoma treatment has stagnated for 17 years, despite advances in understanding its genetics.
- Current mainstays include maximal safe resection, radiotherapy, and temozolomide (TMZ) chemotherapy.
- There is a critical need for innovative therapeutic strategies to improve patient outcomes.
Purpose of the Study:
- To review the neurosurgeon's role in glioblastoma therapy.
- To highlight novel drug delivery techniques and their potential in glioblastoma treatment.
- To discuss the impact of immunotherapy clinical trials and future therapeutic directions.
Main Methods:
- Review of current neurosurgical techniques in glioblastoma management.
- Description of advanced drug delivery methods like blood-brain barrier disruption and convection-enhanced delivery (CED).
- Analysis of outcomes from pivotal immunotherapy clinical trials for glioblastoma.
Main Results:
- Neurosurgical interventions are crucial for integrating new therapeutic modalities.
- Advanced delivery techniques show promise for increasing therapeutic agent concentration in tumors.
- Immunotherapy clinical trials have provided valuable insights into treatment efficacy and challenges.
Conclusions:
- Neurosurgery is central to implementing innovative glioblastoma treatments.
- Emerging therapies, including targeted drug delivery and immunotherapy, offer potential for improved glioblastoma patient prognosis.
- Ongoing research and clinical trials are vital for advancing glioblastoma care.
