What is standard-of-care therapy for the treatment of glioblastoma multiforme (GBM)?

Updated: Jul 28, 2021
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Answer

According to a consensus review by the Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO), standard-of-care therapy for newly diagnosed glioblastoma in adults begins with maximal safe surgical resection. [8] In patients age 18-70 with good functional status, regardless of MGMT promoter methylation, options for subsequent therapy are as follows:

  • Clinical trial participation
  • Radiotherapy for 6 weeks and concurrent temozolomide, followed by six cycles of temozolomide with or without tumor-treating fields
  • In addition to the above, patients with  MGMT methylated tumors may receive 6 weeks of radiotherapy plus six cycles of lomustine and temozolomide, with or without tumor-treating fields.

For patients age 65-70, or those with poor functional status, options in those able to tolerate multimodality therapy are as follows:

  • Radiotherapy for 6 weeks plus concurrent temozolomide, followed by six cycles of temozolomide with or without tumor-treating fields
  • Hypofractionated (or 6 wks) radiotherapy plus concurrent temozolomide followed by six cycles of temozolomide with or without tumor-treating fields

For patients age 65-70, or those with poor functional status, who are unable to tolerate multimodality therapy, therapeutic options are as follows:

  • MGMT methylated tumor - Temozolomide monotherapy, with or without tumor-treating fields
  • MGMT unmethylated tumor - Hypofractionated (or 6 wks) radiotherapy
  • Hospice/best supportive care

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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