New Treatments for Malignant Gliomas: Careful Evaluation and Cautious Optimism Required
Authors: Mark R. Gilbert
Journal: Annals of Internal Medicine (2006)

Editorials7 March 2006New Treatments for Malignant Gliomas: Careful Evaluation and Cautious Optimism RequiredMark R. Gilbert, MDMark R. Gilbert, MDFrom The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-5-200603070-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The treatment of patients with glioblastoma is a showcase for improved technology in many disciplines of medicine. Imaging technology has improved substantially, leading to more accurate and rapid diagnosis; better anatomic localization, which leads to improvements in neurosurgical results; and earlier detection of recurrent or relapsing disease. Surgical techniques have improved with better tumor delineation, which results in a higher percentage of patients having what seems to be complete tumor resection while maintaining or even improving neurologic function. Radiation therapy has also improved, beginning with the recognition that regional treatment is better than whole-brain radiation for most malignant primary brain ...References1. Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:190-8. [PMID: 11780887] CrossrefMedlineGoogle Scholar2. Walker MD, Alexander E, Hunt WE, MacCarty CS, Mahaley MS, Mealey J, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg. 1978;49:333-43. [PMID: 355604] CrossrefMedlineGoogle Scholar3. Walker MD, Green SB, Byar DP, Alexander E, Batzdorf U, Brooks WH, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med. 1980;303:1323-9. [PMID: 7001230] CrossrefMedlineGoogle Scholar4. Fine HA, Dear KB, Loeffler JS, Black PM, Canellos GP. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer. 1993;71:2585-97. [PMID: 8453582] CrossrefMedlineGoogle Scholar5. Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet. 2002;359:1011-8. [PMID: 11937180] CrossrefMedlineGoogle Scholar6. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987-96. [PMID: 15758009] CrossrefMedlineGoogle Scholar7. Sotelo J, Briceño E, López-González MA. Adding chloroquine to conventional treatment for glioblastoma multiforme. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2006;144:337-43. LinkGoogle Scholar8. Curran WJ, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993;85:704-10. [PMID: 8478956] CrossrefMedlineGoogle Scholar9. Hegi ME, Diserens AC, Godard S, Dietrich PY, Regli L, Ostermann S, et al. Clinical trial substantiates the predictive value of O-6-methylguanine-DNA methyltransferase promoter methylation in glioblastoma patients treated with temozolomide. Clin Cancer Res. 2004;10:1871-4. [PMID: 15041700] CrossrefMedlineGoogle Scholar10. Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med. 2005;352:997-1003. [PMID: 15758010] CrossrefMedlineGoogle Scholar11. Mellinghoff IK, Wang MY, Vivanco I, Haas-Kogan DA, Zhu S, Dia EQ, et al. Molecular determinants of the response of glioblastomas to EGFR kinase inhibitors. N Engl J Med. 2005;353:2012-24. [PMID: 16282176] CrossrefMedlineGoogle Scholar12. Valtonen S, Timonen U, Toivanen P, Kalimo H, Kivipelto L, Heiskanen O, et al. Interstitial chemotherapy with carmustine-loaded polymers for high-grade gliomas: a randomized double-blind study. Neurosurgery. 1997;41:44-8; discussion 48-9. [PMID: 9218294] CrossrefMedlineGoogle Scholar13. Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, et al. A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro-oncol. 2003;5:79-88. [PMID: 12672279] CrossrefMedlineGoogle Scholar14. Grossman SA, Wharam M, Sheidler V, Kleinberg L, Zeltzman M, Yue N, et al. Phase II study of continuous infusion carmustine and cisplatin followed by cranial irradiation in adults with newly diagnosed high-grade astrocytoma. J Clin Oncol. 1997;15:2596-603. [PMID: 9215830] CrossrefMedlineGoogle Scholar15. Grossman SA, O'Neill A, Grunnet M, Mehta M, Pearlman JL, Wagner H, et al. Phase III study comparing three cycles of infusional carmustine and cisplatin followed by radiation therapy with radiation therapy and concurrent carmustine in patients with newly diagnosed supratentorial glioblastoma multiforme: Eastern Cooperative Oncology Group Trial 2394. J Clin Oncol. 2003;21:1485-91. [PMID: 12697871] MedlineGoogle Scholar16. Gilbert MR. Neuro-oncology clinical trials: promise and pitfalls [Editorial]. Ann Oncol. 2001;12:149-50. [PMID: 11300316] CrossrefMedlineGoogle Scholar17. Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol. 2002;20:1375-82. [PMID: 11870182] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030.Grant Support: None.Disclosures: None disclosed.Corresponding Author: Mark R. Gilbert, MD, Department of Neuro-oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; e-mail, [email protected]org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAdding Chloroquine to Conventional Treatment for Glioblastoma Multiforme Julio Sotelo , Eduardo Briceño , and Miguel Angel López-González Metrics Cited ByNHERF1 Between Promises and Hopes: Overview on Cancer and Prospective OpeningsTemozolomide-Mediated Apoptotic Death Is Improved by Thymoquinone in U87MG Cell LineTransferability of cocrystallization propensities between aromatic and heteroaromatic amidesH-bonding and stacking interactions between chloroquine and temozolomideHydrogen bonded and stacked geometries of the temozolomide dimerClinical Evidence and Radiobiological Background of Particle Radiation TherapyInteraction between temozolomide and HCl: Preferred binding sitesRegioselectivity of the interaction of temozolomide with borane and boron trifluorideInteraction between temozolomide and water: Preferred binding sitesSynergistic suppression of noscapine and conventional chemotherapeutics on human glioblastoma cell growthNHERF-1: Modulator of Glioblastoma Cell Migration and InvasionMolecular strategies for the treatment of malignant glioma—genes, viruses, and vaccinesInstitutional experience with chloroquine as an adjuvant to the therapy for glioblastoma multiforme 7 March 2006Volume 144, Issue 5Page: 371-373KeywordsBrainChemotherapyChloroquineClinical trialsGlioblastoma multiformePatientsRadiation therapySurgical resectionTumor resection ePublished: 7 March 2006 Issue Published: 7 March 2006 CopyrightCopyright © 2006 by American College of Physicians. 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