title: Treatment options in newly diagnosed glioblastoma.
abstract: Regardless of MGMT status, standard of care for a patient with newly diagnosed glioblastoma (GBM), age ≤70 years, and adequate functional status is radiation and concurrent temozolomide followed by adjuvant temozolomide. For elderly patients, recent studies have suggested that standard radiation, hypofractionated radiation, or single agent temozolomide are acceptable treatment options. Randomized phase III studies of bevacizumab in combination with radiation and temozolomide for newly diagnosed GBM have completed accrual. Preliminary results reveal a clear progression-free survival benefit. Overall survival appears unchanged although follow-up has not fully matured and cross-over to bevacizumab upon progression among control patients may limit definitive conclusions. Although bevacizumab in the upfront setting may be considered for a subset of patients, it should not be used routinely in newly diagnosed patients until final results are available. Clinical trials evaluating promising therapeutics given in combination with standard temozolomide chemoradiation are critically needed.
authors.affiliation: Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02215, USA.
authors.forename: Eudocia Q
authors.initials: EQ
authors.lastname: Lee
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.forename: David A
authors.initials: DA
authors.lastname: Reardon
references.citation: Neuro Oncol. 2008 Jun;10(3):355-60
references.pmid: 18436627
references.citation: Lancet Oncol. 2006 May;7(5):392-401
references.pmid: 16648043
references.citation: Am J Phys Med Rehabil. 2011 May;90(5 Suppl 1):S50-62
references.pmid: 21765264
references.citation: J Natl Cancer Inst. 2008 Jun 4;100(11):773-83
references.pmid: 18505970
references.citation: Cancer Immunol Immunother. 2013 Jan;62(1):125-35
references.pmid: 22847020
references.citation: J Neurooncol. 2012 May;107(3):537-44
references.pmid: 22124725
references.citation: Neuro Oncol. 2012 Nov;14 Suppl 5:v1-49
references.pmid: 23095881
references.citation: Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):853-60
references.pmid: 15465203
references.citation: N Engl J Med. 2005 Mar 10;352(10):987-96
references.pmid: 15758009
references.citation: Neuro Oncol. 2011 Oct;13(10):1049-58
references.pmid: 21784756
references.citation: J Neurosurg. 2012 Nov;117(5):851-9
references.pmid: 22978537
references.citation: Future Oncol. 2011 Mar;7(3):339-54
references.pmid: 21417900
references.citation: Lancet Oncol. 2012 Sep;13(9):916-26
references.pmid: 22877848
references.citation: Adv Exp Med Biol. 2012;746:12-25
references.pmid: 22639156
references.citation: Lancet Oncol. 2009 May;10(5):459-66
references.pmid: 19269895
references.citation: Lancet Oncol. 2012 Jul;13(7):707-15
references.pmid: 22578793
references.citation: Neuro Oncol. 2003 Apr;5(2):79-88
references.pmid: 12672279
references.citation: Ther Clin Risk Manag. 2007 Oct;3(5):707-15
references.pmid: 18472995
references.citation: Cancer Treat Rev. 2013 Jun;39(4):350-7
references.pmid: 22722053
references.citation: Core Evid. 2012;7:93-103
references.pmid: 23055947
references.citation: N Engl J Med. 2007 Apr 12;356(15):1527-35
references.pmid: 17429084
references.citation: J Clin Oncol. 2009 Mar 1;27(7):1082-6
references.pmid: 19139429
references.citation: Neurology. 2008 Mar 4;70(10):779-87
references.pmid: 18316689
references.citation: Biochim Biophys Acta. 2011 Jun;1807(6):577-94
references.pmid: 20804725
references.citation: Clin Neurosurg. 2012;59:79-81
references.pmid: 22960517
references.citation: Clin Adv Hematol Oncol. 2007 Nov;5(11):894-902, 907-15
references.pmid: 18185489
references.citation: J Clin Oncol. 2010 Apr 10;28(11):1963-72
references.pmid: 20231676
references.citation: J Clin Oncol. 2004 May 1;22(9):1583-8
references.pmid: 15051755