Current FDA-Approved Therapies for High-Grade Malignant Gliomas

• Authors: Jacob P Fisher, Southern Virginia University; David Adamson, Emory University
• Journal Title: BIOMEDICINES
• Volume: Volume 9, Number 3
• Publisher: MDPI | 2021-03-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/biomedicines9030324
• Subjects: Chemistry, Biochemistry; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Biochemistry & Molecular Biology; Medicine, Research & Experimental; Pharmacology & Pharmacy; Research & Experimental Medicine; high-grade glioma; malignant glioma; standard of care; glioblastoma; temozolomide; lomustine; carmustine; bevacizumab; tumor treatment fields; FDA-approved; FLUORESCENCE-GUIDED SURGERY; RECURRENT GLIOBLASTOMA; HYPOFRACTIONATED RADIOTHERAPY; ADJUVANT TEMOZOLOMIDE; 5-AMINOLEVULINIC ACID; BEVACIZUMAB TREATMENT; ELDERLY-PATIENTS; GLIADEL WAFERS; PHASE-II; SURVIVAL

Abstract

The standard of care (SOC) for high-grade gliomas (HGG) is maximally safe surgical re-section, followed by concurrent radiation therapy (RT) and temozolomide (TMZ) for 6 weeks, then adjuvant TMZ for 6 months. Before this SOC was established, glioblastoma (GBM) patients typically lived for less than one year after diagnosis, and no adjuvant chemotherapy had demonstrated significant survival benefits compared with radiation alone. In 2005, the Stupp et al. randomized controlled trial (RCT) on newly diagnosed GBM patients concluded that RT plus TMZ compared to RT alone significantly improved overall survival (OS) (14.6 vs. 12.1 months) and progression-free survival (PFS) at 6 months (PFS6) (53.9% vs. 36.4%). Outside of TMZ, there are four drugs and one device FDA-approved for the treatment of HGGs: lomustine, intravenous carmustine, carmustine wafer implants, bevacizumab (BVZ), and tumor treatment fields (TTFields). These treatments are now mainly used to treat recurrent HGGs and symptoms. TTFields is the only treatment that has been shown to improve OS (20.5 vs. 15.6 months) and PFS6 (56% vs. 37%) in comparison to the current SOC. TTFields is the newest addition to this list of FDA-approved treatments, but has not been universally accepted yet as part of SOC.