Ishan Perera

Abstract

Glioblastoma multiforme (GBM), WHO Grade IV astrocytoma, accounts for 50.1% of all malignant brain tumors, the most common primary brain tumor. The disease courts a poor prognosis, with a median survival of 14 months with standard therapy. Treatment of both primary and secondary GBM has been challenging, requiring a multi-faceted therapeutic plan including various implementations of gross total resection, chemotherapy, radiotherapy, and select targeted therapies. This study completes a comprehensive systematic review of all current standard treatments and treatment protocols elucidating the clinical significance of each treatment modality to provide a clinically significant protocol recommendation based on median survival time and progression-free survival. Initial treatment approaches are grounded in surgical total resection, the goal of which is to remove maximal tumor mass while ensuring maintenance of neurological status. First-line chemotherapy, Temozolomide (TMZ), is dosed concurrently with radiotherapy that is typically delivered stereotactically. This combination therapy, termed the Stupp Regimen, typically adds 2 months to the 14-month median survival. Current secondary and tertiary treatment protocols similarly alter this primary treatment approach. TMZ with Bevacizumab, for example, a second-line treatment, does not improve median survival, instead, it synergistically increases patient-reported quality of life and symptom management, while Bevacizumab alone, a third-line treatment, increased median survival by 6.6 months and progression-free survival by 2.9 months. In completion of this ongoing study, a comprehensive list of standard first, second, and third-line treatment regimens will be compiled. These regimens will then be analyzed for clinically significant benefits to the patient, most typically measured as added median survival time and progression-free survival. The novelty and variability in these standard treatment approaches make it difficult for providers to remain up to date, this study will become a comprehensive reference to standard treatment while making clear recommendations based on clinically significant findings.

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