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Glioblastoma: Background, Standard Treatment Paradigms, and Supportive Care Considerations

Published online by Cambridge University Press:  01 January 2021

Susan V. Ellor ,
Teri Ann Pagano-Young  and
Nicholas G. Avgeropoulos
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Extract

While primary malignant brain tumors account for only two percent of all adult cancers, these neoplasms cause a disproportionate amount of cancer-related disabilities and death. The five-year survival rates for brain tumors are the third lowest among all types of cancer. Malignant gliomas (glioblastoma and anaplastic astrocytoma) comprise the most common types of primary central nervous system (CNS) tumors and have a combined incidence of five to eight cases per 100,000 people. The median survival rate of conservatively treated patients with malignant gliomas is 14 weeks; with surgical resection alone, 20 weeks; with surgery and radiation, 36 weeks; and with the addition of newer biochemotherapies such as temozolomide and bevacizumab, upward of 14-18 months.

The profound cost of caring for terminally ill patients with primary malignant brain tumors raises ethical considerations for the American public; the stewardship of health care dollars for the population at large maintains a juxtaposed tension against a dynamic, necessary balance of hope, care, rehabilitation and research efforts for affected patients and their advocates.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 42 , Issue 2 , Summer 2014 , pp. 171 - 182
Copyright
Copyright © American Society of Law, Medicine and Ethics 2014

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References

Salcman, M. et al., “Long-Term Survival in Patients with Malignant Astrocytoma,” Neurosurgery 34, no. 2 (1994): 213–219; Fine, H. et al., “Meta-Analysis of Radiation Therapy with and without Adjuvant Chemotherapy for Malignant Gliomas in Adults,” Cancer 71, no. 8 (1993): 2585–2597; Salcman, M., “Survival in Glioblastoma: Historical Perspective,” Neurosurgery 7, no. 5 (1980): 435–439; Huncharek, M. Muscat, J., “Treatment of Recurrent High Grade Astrocytoma;Results of a Systematic Review of 1,415 Patients,” Anticancer Research 18, no. 2B (1998): 1303–1312; Stupp, R. et al., “Radiotherapy Plus Concomitant and Adjuvant Temozolomide for Glioblastoma,” New England Journal of Medicine 352, no. 10 (2005): 987–996; Cohen, M. et al., “FDA Drug Approval Summary: Bevacizumab (Avastin) as Treatment of Recurrent Glioblastoma Multiforme,” Oncologist 14, no. 11 (2009): 1131–1138; “Adult Brain Tumors Treatment (PDQ): Classification of Adult Brain Tumors,” National Cancer Institute, last modified May 14, 2013, available at <http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional/page2>(last visited May 13, 2014); Avgeropoulos, N. Batchelor, T., “New Treatment Strategies for Malignant Gliomas,” The Oncologist 4, no. 3 (1999): 209–224.CrossRefGoogle Scholar
Id. (Salcman, et al., 1994). Ropper, A. Samuels, M., Adams and Victor's Principles of Neurology, 9th ed. (McGraw-Hill Professional, 2009).Google Scholar
Id. (Fine, et al.,).Google Scholar
See Salcman, et al., (1994), supra note 1.Google Scholar
See Salcman, (1980), supra note 1.Google Scholar
See Salcman, et al., (1994), supra note 1; Chang, S. et al., Principles and Practice of Neuro-Oncology: A Multidisciplinary Approach, ed. by Mehta, M. (Demos Medical, 2010).Google Scholar
See Salcman, (1980), supra note 1.Google Scholar
See Fine, et al., supra note 1.Google Scholar
See Salcman, et al., (1994), supra note 1; Salcman, (1980), supra note 1.Google Scholar
See Salcman, (1980), supra note 1.Google Scholar
See Huncharek, Muscat, , supra note 1; Delattre, J.-Y., “Erythema Multiforme and Stevens-Johnson Syndrome in Patients Receiving Cranial Irradiation and Phenytoin,” Neurology 38, no. 2 (1988): 194–198.CrossRefGoogle Scholar
See Fine, et al., supra note 1.Google Scholar
See Cohen, et al., supra note 1; Wood, J. et al., “The Prognostic Importance of Tumor Size in Malignant Gliomas: AComputed Tomographic Scan Study by the Brain Tumor Cooperative Group,” Journal of Clinical Oncology 6, no. 2 (1988): 338–343.CrossRefGoogle Scholar
Brandes, A. et al., “Appropriate End-Points for Right Results in the Age of Antiangiogenic Agents: Future Options for Phase II Trials in Patients with Recurrent Glioblastoma,” European Journal of Cancer 48, no. 6 (2012): 896–903.CrossRefGoogle Scholar
Macdonald, D. et al., “Response Criteria for Phase II Studies of Supratentorial Malignant Glioma,” Journal of Clinical Oncology 8, no. (1990): 1277–1280.CrossRefGoogle Scholar
See Fine, et al., supra note 1.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Fine, et al., supra note 1.Google Scholar
Id.Google Scholar
See Cohen, et al., supra note 1.Google Scholar
See Salcman, (1980), supra note 1.Google Scholar
Hospice Patients Alliance, “Karnofsky Performance Status Scale Definitions Rating (%) Criteria,” available at <http://www.hospicepatients.org/karnofsky.html>(last visited March 28, 2014).(last+visited+March+28,+2014).>Google Scholar
Pignatti, F. et al., “Prognostic Factors for Survival in Adult Patients with Cerebral Low-Grade Glioma,” Journal of Clinical Oncology 20, no. 8 (2002): 2076–2084; Tabatabai, G., “Molecular Diagnostics of Gliomas: The Clinical Perspective,” Acta Neuropathologica 120, no. 5 (2010): 585–592.Google Scholar
Riemenschneider, M., “MGMTPromoter Methylation in Malignant Gliomas,” Targeted Oncology 5, no. 3 (2010): 161–165; Sciuscio, D., “Extent and Patterns of MGMTPromoter Methylation in Glioblastoma- and Respective Glioblastoma-Derived Spheres,” Clinical Cancer Research 17, no. 2 (2011): 255–266; Weller, M. et al., “MGMTPromoter Methylation in Malignant Gliomas: Ready for Personalized Medicine?” Nature Reviews Neurology 6, no. 1 (2010): 39–51.CrossRefGoogle Scholar
Mellinghoff, I., “Molecular Determinants of the Response of Glioblastomas to EGFR Kinase Inhibitors,” New England Journal of Medicine 353, no. 19 (2005): 2012–2024.CrossRefGoogle Scholar
Id.Google Scholar
Ford, E. et al., “Systematic Review of Supportive Care Needs in Patients with Primary Malignant Brain Tumors,” Neuro-Oncology 14, no. 4 (2012): 392–404; Brem, S. et al., “Central Nervous System Cancers,” JNCCN 11, no. 6 (2012): 352–400.CrossRefGoogle Scholar
Simpson, J. et al., “Influence of Location and Extent of Surgical Resection on Survival of Patients with Glioblastoma Multiforme: Results of Three Consecutive Radiation Therapy Oncology Group (RTOG) Clinical Trials,” International Journal of Radiation Oncology*Biology*Physics* 26, no. 2 (1993): 239–244; Lacroix, M. et al., “A Multivariate Analysis of 416 Patients with Glioblastoma Multiforme: Prognosis, Extent of Resection, and Survival,” Journal of Neurosurgery 95, no. 2 (2001): 190–198.CrossRefGoogle Scholar
Yabroff, R. K., “Patterns of Care and Survival for Patients with Glioblastoma Multiforme Diagnosed During 2006,” Neuro-Oncology 14, no. 3 (2012): 351–359.CrossRefGoogle Scholar
Id.Google Scholar
Laws, E. et al., “Survival Following Surgery and Prognostic Factors for Recently Diagnosed Malignant Glioma: Data from the Glioma Outcomes Project,” Journal of Neurosurgery 99, no. 3 (2003): 467–473.CrossRefGoogle Scholar
Perry, J. et al., “Phase II Trial of Continuous Dose-Intense Temozolomide in Recurrent Malignant Glioma: RESCUE Study,” Journal of Clinical Oncology 28, no. 12 (2010): 2051–2057; Stupp, R. et al., “Effects of Radiotherapy with Concomitant and Adjuvant Temozolomide Versus Radiotherapy Alone on Survival in Glioblastoma in a Randomised Phase III Study: 5-Year Analysis of the EORTC-NCIC Trial,” The Lancet Oncology 10, no. 5 (2009): 459–466.CrossRefGoogle Scholar
Stupp, R. et al., “Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma,” New England Journal of Medicine 352, no. 10 (2005): 987–996.CrossRefGoogle Scholar
Mellinghoff, I., “Signal Transduction Inhibitors and Antiangiogenic Therapies for Malignant Glioma,” GLIA 59, no. 8 (2011): 1205–1212.CrossRefGoogle Scholar
See Perry, et al., supra note 33; Stupp, , supra note 34; Wick, A. et al., “Rechallenge with Temozolomide in Patients with Recurrent Gliomas,” Journal of Neurology 256, no. 5 (2009): 734–741.CrossRefGoogle Scholar
See Stupp, et al., supra note 34.Google Scholar
Stupp, R. et al., “Promising Survival for Patients with Newly Diagnosed Glioblastoma Multiforme Treated with Concomitant Radiation plus Temozolomide Followed by Adjuvant Temozolomide,” Journal of Clinical Oncology 20, no. 5 (2002): 1375–1382.CrossRefGoogle Scholar
See Stupp, et al., supra note 34.Google Scholar
Groves, M. Plummer, A., “Helping Patients Make the Best Decision,” Neuro-oncology 18, no. 2 (2012): 421–425; Berrocal, A. et al., “Extended-Schedule Dose-Dense Temozolomide in Refractory Gliomas,” Journal of Neuro-Oncology 96, no. 3 (2010): 417–422.Google Scholar
Hegi, M., “MGMTGene Silencing and Benefit from Temozolomide in Glioblastoma,” New England Journal of Medicine 352 (2005): 997–1003.CrossRefGoogle Scholar
Groves, M. Plummer, A., “Helping Patients Make the Best Decision Regarding Duration of Temozolomide Chemotherapy Treatment,” Continuum 18, no. 2 (2012): 421–425.Google Scholar
See Stupp, et al., supra note 34.Google Scholar
Id.Google Scholar
Stewart, L., “Chemotherapy in Adult High-Grade Glioma: ASystematic Review and Meta-Analysis of Individual Patient Data from 12 Randomised Trials,” The Lancet 359, no. 9311 (2002): 1011–1018.Google Scholar
See Fine, et al., supra note 1.Google Scholar
Walbert, T., “Combination of 6-Thioguanine, Capecitabine, and Celecoxib with Temozolomide or Lomustine for Recurrent High-Grade Glioma,” Journal of Neuro-Oncology 102, no. 2 (2011): 273–280.CrossRefGoogle Scholar
See Cohen, et al., supra note 1.Google Scholar
Murray, L. J. Bridgewater, C. H. Levy, D., “Carboplatin Chemotherapy in Patients with Recurrent High-Grade Glioma,” Clinical Oncology 23, no. 1 (2011): 55–61.CrossRefGoogle Scholar
See Groves, Plummer, , supra note 41.Google Scholar
Id.Google Scholar
See Cohen, et al., supra note 1.Google Scholar
Gorlia, T. et al., “New Prognostic Factors and Calculators for Outcome Prediction in Patients with Recurrent Glioblastoma: A Pooled Analysis of EORTC Brain Tumour Group Phase I and II Clinical Trials,” European Journal of Cancer 48, no. 8 (2012): 1176–1184.CrossRefGoogle Scholar
Dropcho, E. J., “Should the Cost of Care for Patients with Glioblastoma Influence Treatment Decisions?” Continuum 18, no. 2 (2012): 416–420.Google Scholar
Id.Google Scholar
Bai, R. Y. et al., “Molecular Targeting of Glioblastoma: Drug Discovery and Therapies,” Trends in Molecular Medicine 17, no. 6 (2011): 301–312.CrossRefGoogle Scholar
See Brandes, et al., supra note 14.Google Scholar
See Bai, et al., supra note 56.Google Scholar
See Dropcho, , supra note 54.Google Scholar
Crott, R., “The Economics of Temozolomide in Brain Cancer,” Expert Opinion in Pharmacotherapy 8, no. 12 (2007): 1923–1929.CrossRefGoogle Scholar
Calhoun-Eagan, R., “Psychological and Social Impact of Being a Brain Tumor Survivor: Adult Issues,” in Goldman, S. Turner, C. D., eds., Late Effects of Treatment for Brain Tumors (New York: Springer Science+Business Media, LLC, 2009): At 309–316.CrossRefGoogle Scholar
Stupp, R. et al., “Novocure-TTF-100A Versus Physician's Choice Chemotherapy in Recurrent Glioblastoma: ARandomised Phase III Trial of a Novel Treatment Modality,” European Journal of Cancer 48, no. 14 (2012): 2192–202.CrossRefGoogle Scholar
Gehring, K. et al., “Predictors of Neuropsychological Improvement Following Cognitive Rehabilitation in Patients with Gliomas,” Journal of the International Neuropsychological Society 17, no. 2 (2011): 256–266.CrossRefGoogle Scholar
Janda, M. et al., “Quality of Life among Patients with a Brain Tumor and Their Careers,” Journal of Psychosomatic Research 63, no. 6 (2007): 617–623.CrossRefGoogle Scholar
Id.Google Scholar
Gehring, K. et al., “Interventions for Cognitive Deficits in Patients with a Brain Tumor: An Update,” Expert Reviews of Anticancer Therapy 10, no. 11 (2010): 1779–1795; Giovagnoli, A. R., “Investigation of Cognitive Impairments in People with Brain Tumors,” Journal of Neuro-Oncology 108, no. 2 (2012): 277–283.CrossRefGoogle Scholar
Gofton, T. et al., “Identifying the Palliative Care Needs of Patients Living with Cerebral Tumors and Metastases: A Retrospective Analysis,” Journal of Neuro-Oncology 108, no. 3 (2012): 527–534.CrossRefGoogle Scholar
Grisold, W. et al., “Brain Tumour Treatment: The Concept of Inter- and Multidisciplinary Treatment,” Wiener Medizinische Wochenschrift 156, no. 11–12 (2006): 329–331.CrossRefGoogle Scholar
Ford, E. et al., “Systematic Review of Supportive Care Needs in Patients with Primary Malignant Brain Tumors,” Neuro-Oncology 14, no. 4 (2012): 392–404.CrossRefGoogle Scholar
Id.Google Scholar