gms | German Medical Science

Objective: There is no evidence that any salvage therapy is superior in the treatment of recurrent glioblastoma. Prospective randomized controlled trials comparing the current salvage protocols are unlikely to occur. Facing the dismal prognosis in these patients, a progression-free survival (PFS) of 12 months under salvage therapy may be considered as effective treatment and is less prone to be due to treated pseudoprogression. Identification of regimes with potentially sustained tumor control is desirable.

Method: 208 patients with histologically proven glioblastoma followed by standard first line treatment between 2007 and 2012 were evaluated. By chart review, therapy regimes and PFS were evaluated retrospectively.

Results: 82 patients received at least one salvage regime. 72 resections of recurrent tumor were performed in 59 patients, 7 patients underwent second radiotherapy. 138 individual chemotherapies were applied. In brief (n): temozolomide (TMZ) 5/28 (18), dose-dense TMZ (52), metronomic low dose TMZ (19), lomustine/dose-denseTMZ (18), nimustine (11), bevacizumab (13), others (8). 14 of 138 (10.1%) salvage therapies resulted in a PFS of at least 12 months. In detail (n, % of patients treated, respectively): TMZ 75-100mg/qm on day 1-5 of 28 day cycle (2, 11%), TMZ 75-100mg/qm on day 1-5 of 7 day cycle (5, 10%), metronomic TMZ 20mg/qm b.i.d. and celecoxib 200mg/d (2, 11%), lomustine 70mg/qm on day 1 of a 6 weeks cycle in combination with dose-dense TMZ (1, 6%), nimustine 70mg/qm every 6 weeks (1, 9%), bevacizumab 10mg/kg every 2 weeks (3, 23%). Median PFS under salvage therapy in this group is 16.5 months.

Conclusions: Sustained tumor control is achievable in 10% of salvage treatments for recurrent glioblastoma. This novel perspective may confirm the role of bevacizumab and offers alternative regimes as salvage treatment, if applied to a future multicenter retrospective cohort.