Recommendations for Front-line Systemic Therapy for Glioblastoma

Performance status is an attempt to quantify cancer patients general well being. Temozolomide is an oral chemotherapy drug that damages the DNA of cancer cells, killing them. If you are below 70 years old, and have good performance status of less than or equals to 2, it is recommended to use radiation therapy spread out over a few doses concurrent with temozolomide followed by adjuvant temozolomide. A drug taken in an adjuvant setting is given together with another treatment to increase its effectiveness.

Dose-dense therapy is a type of therapy that aims to achieve maximum tumour kill by increasing the rate of chemotherapy delivery. Dose-dense therapy is not recommended.

If you are above 70 years old and have good performance status, treatment options include radiotherapy given over a shorter period of time compared to normal, temozolomide with deferred radiotherapy or radiotherapy with concurrent temozolomide followed by adjuvant temozolomide.

MGMT promoter is a segment of gene that can be used to evaluate the outcomes of glioblastoma patients by checking to see if it contains a chemical group known as a methyl group. If you are above 70 years old and have good performance status, we suggest that you go for tests to check for the presence of such methyl groups in your MGMT promoter. If methyl groups are present, we recommened temozolomide therapy.

Bevacizumab is a drug that inhibits growth of blood vessels that cancers need to support their growth, thus preventing the growth of cancer cells. The addition of the bevacizumab as upfront therapy is not recommended.

Some cancer cells have proteins on their surface called epidermal growth factor receptors (EGFRs). EGFR inhibitors such as nimotuzumab inhibit the function of these proteins, preventing them from promoting growth of cancer cells. The role of nimotuzumab as front-line therapy in this case is debated.

Procarbazine, lomustine and vincristine (PCV) is a combination of 3 chemotherapy drugs used together in a chemotherapy regimen. Procarbazine damages cancer cell DNA, causing cancer cells to die. Lomustine inhibits DNA and RNA synthesis by cancer cells, causing them to stop growing. Vincristine stops cancer cells from dividing properly, thus causing them to die. If you have poor performance status, some options that are recommended include treatment with PCV, temozolomide given alone, radiotherapy given alone or best supportive care, a type of medical care that focuses on relieving the symptoms caused by serious illnesses. It should be noted that there is a lack of data on front-line therapy in patients with poor performance status.