Recommendations for Systemic Therapy for Recurrent Malignant Gliomas

There is currently no established systemic therapy for recurrent malignant glioma.

Performance status is an attempt to quantify cancer patients general well being.For patients with good performance status, reasonable chemotherapy options include temozolomide, lomustine, treatment with a combination ofprocarbazine, lomustine and vincristine (PCV), cyclophosphamide, platinum-based agents and irinotecan.Temozolomide is an oral chemotherapy drug that damages the DNA of cancer cells, killing them. Lomustine inhibits DNA and RNA synthesis by cancer cells, causing them to stop growing. (PCV) is a combination of 3 chemotherapy drugs used together in a chemotherapy regimen. Procarbazine damages cancer cell DNA, causing cancer cells to die. Vincristine stops cancer cells from dividing properly, thus causing them to die. Cyclophosphamide is an anti-cancer chemotherapy drug. Irinotecan is toxic to cancer cells.

Bevacizumab, given alone or in combination with other chemotherapy drugs, may also be considered in recurrent glioblastoma. Bevacizumab is a drug that inhibits growth of blood vessels that cancers need to support their growth, thus preventing the growth of cancer cells.

For patients with poor performance status, best supportive care, a type of medical care that focuses on relieving the symptoms caused by serious illnesses, is reasonable.