What are the AANS/CNS clinical practice guidelines for use of cytotoxic chemotherapy in the treatment of glioblastoma multiforme (GBM)?

Updated: Jul 01, 2019
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Answer

In an evidence-based clinical practice guideline formulated to address the impact of cytotoxic chemotherapy on disease control and survival in adults with progressive glioblastoma, Olson et al make the following recommendations [61] :

  • Temozolomide is recommended over procarbazine in patients who have a first relapse of glioblastoma after treatment with nitrosourea chemotherapy or who had no prior cytotoxic chemotherapy at the time of initial therapy (level II recommendation)

  • Carmustine (BCNU)-impregnated biodegradable polymer wafers are recommended for use as a surgical adjunct when cytoreductive surgery is indicated; the associated toxicities must be taken into account (level II recommendation

  • Various agents of uncertain benefit may be considered for use, depending on the treating clinician's clinical judgment; prior treatment exposure, systemic health, and tolerance must be taken into account; enrollment in clinical trials of these agents is encouraged (level III recommendation)

Anticonvulsant medications are usually maintained, and levels are checked intermittently. Steroids are tapered to lower doses for radiation therapy and then tapered further if possible. While taking steroids, patients should be maintained on an antiulcer agent.


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