[Frontiers in Bioscience 18, 676-684, January 1, 2013]

Recent therapeutic advances and insights of recurrent glioblastoma multiforme

Juxiang Chen1, Tao Xu1

1Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China


1. Abstract
2. Introduction
3. Therapeutic strategies
3.1. Re-operation
3.2. Radiotherapy and Gamma-knife surgery
3.3. Chemotherapy
3.3.1. Temozolomide
3.3.2. Fotemustine
3.3.3. Other chemotherapy regimen
3.4. Anti-angiogenic therapy
3.5. Immunotherapy
4. Conclusion
5. Acknowledgements
6. References


Despite recent therapeutic advances, most patients with glioblastoma multiforme (GBM) experience disease recurrence, with very poor prognosis. Much work still needs to done to improve the treatment efficacy. The optimal management of patients with recurrent GBM is still controversial. This article summarizes the current status of therapeutic strategies in recurrent glioblastoma patients, with an emphasis on more novel approaches and important recent progress. The clinical evidence of current treatment strategies were collected and reviewed. Patients still need comprehensive treatment for recurrent GBM. Surgery may be useful as adjuvant treatment for patients with symptoms due to the effect of the mass or for patients requiring definitive histopathology, but it generally should be combined with another treatment modality; high-precision re-irradiation such as stereotactic radiosurgery or gamma knife is another option. Chemotherapy like fotemustine, or a metronomic schedule of temozolomide regimens and anti-angiogenic agents like bevacizumab could also be considered. Other targeted molecular inhibitors or anti-angiogenic therapies, and immunotherapies are still under investigation and their efficacy needs to be evaluated further in the future.