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. Typically, both primary and secondary GBM treatment regimens modify the traditional Stupp Regimen including gross total resection, chemotherapy, and radiotherapy; however, regardless of the developed therapeutic plan the disease courts a poor median survival of 14 months. This comprehensive systematic review of novel therapeutic approaches to GBM treatment aims to provide an extensive catalog of treatment regimens, clinically significant benefits such as median survival time and progression-free survival, and to provide a recommendation of the best novel approaches for further study. Novel treatment methods including tumor-treating fields (TTFields), carmustine wafers, viral therapy, and lab-synthesized molecules, such as Hyaluronic acid (7 kDa)-b-polylactic acid (HA7-PLA) polymersome purport positive outcomes between 17.5 to 36 months of median survival. TTFields in addition to Temozolomide (TMZ) when compared to TMZ alone resulted in 2.7 additional months of progression-free survival and 4.9 to 5.2 months of added median survival time. Placement of greater than 12 carmustine wafers at initial resection improved progression-free survival by 21 months and median survival by 22.5 months. Additionally, wafer placement after recurrence surgery increased median survival time by 3.5 months. Viral therapy, recombinant non-pathogenic polio-rhinovirus chimera (PVSRIPO), extended median survival by 24 to 36 months. Synthesized molecules, such as HA7-PLA polymersome, are some of the most novel approaches to GBM treatment, thus they are currently discussed without human application data. Completion of this comprehensive review will produce an up-to-date list of novel and experimental treatment approaches with reported clinically significant data points - median survival time and progression-free survival. In turn, this study will elucidate the most clinically significant novel approaches to GBM treatment based on the most current published treatment approaches, this may then be used as a guide for future study design and reference.

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