The role of chemotherapy in recurrent malignant gliomas: an overview

Cancer Investigation
Alba A Brandes, M V Fiorentino

Abstract

First-line treatment of malignant gliomas invariably includes surgery when feasible, and often adjuvant radiotherapy with or without chemotherapy; at progression or recurrence, the only remaining possibility is chemotherapy. While the role of first-line treatment has been established by many randomized studies, second-line treatment is not as well defined. To analyze the difficulties encountered with cytotoxic drugs in relation to both the blood-brain barrier and drug resistance, we examined the results obtained by single-agent chemotherapy, drug combinations, and biological response modifiers. Our findings confirmed that the nitrosoureas are the most active substances at the time of recurrence; these agents give an approximately 30% global response rate, with about 20 weeks' survival. Although no comparative randomized studies regarding single- versus multiple-agent chemotherapy are available, the latter approach, including nitrosourea, can obtain an up to 40% rate of response, with survival ranging from 30 to 50 weeks. The role of interferons has been very controversial; individually, alpha- and beta-interferons seem to give a 20% response rate, with 20 weeks' survival. To date, they have never been used in combination with c...Continue Reading

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