Management of Progressive Glioblastoma (CNS, 2022)

Updated guidelines for the management of progressive glioblastoma were published in May 2022 by the Congress of Neurological Surgeons (CNS) in Neurosurgery.^[1]

Imaging

Gadolinium contrast-enhanced magnetic resonance imaging (MRI) is recommended for diagnosis of progressive glioblastoma multiforme (pGBM). Diffusion-weighted imaging should be considered as part of the standard MRI sequences used.

18-Fluorodeoxyglucose (FDG) is not recommended for routine diagnosis. Techniques using newer radiotracers may assist in the diagnosis.

Role of Cytoreductive Surgery

Cytoreductive surgery is recommended for patients with symptomatic pGBM. It is also recommended to improve overall survival in pGBM patients.

Pathology Testing

Repeat assessment of 06-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase status is not indicated.

Programmed death ligand (PDL) 1/mismatch repair enzyme activity is not a useful component of standard diagnostic testing.

If epidermal growth factor receptor amplification was not previously measured, its assessment at progression may be of diagnostic value.

Large panel sequencing may be considered in patients who are eligible for or interested in molecularly guided therapy or clinical trials.

Use of Cytotoxic Agents

Benefit may be derived from treatment with temozolomide (TMZ; especially with progression after > 5 months off TMZ).

Fotemustine is suggested in elderly patients with methylated MGMT promoter status.

Tumor treatment fields (TTFs) with other chemotherapy may be considered for adult patients.

The following are not suggested: (1) TMZ combined with other cytotoxic agents as standalone therapy; (2) other chemotherapeutic agents (including platinum compounds and topoisomerase inhibitors); (3) other cytotoxic therapies (eg, perillyl alcohol or ketogenic diet) as standalone therapy; and (4) oncolytic virotherapy.

Role of Radiation Therapy

Reirradiation should be considered for patients with pGBM; it can be safely used in elderly patients.

Value of Targeted Therapy and Immunotherapy

Bevacizumab does not provide increased overall survival when used to treat pGBM. There is not sufficient evidence to identify benefits and harms associated with its use in combination with other agents.

For more information, please go to Glioblastoma Multiforme.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Management of Progressive Glioblastoma Clinical Practice Guidelines (CNS, 2022) - Medscape - May 31, 2022.

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

My Alerts