Recent advance and updates in chemotherapy for Glioma

The approval of BCNU wafers and bevacizumab (BEV) has widened the therapeutic options for malignant glioma patients. Although these new drugs contribute to improve disease management in patients, there are some pitfalls associated with the use of these new drugs. On the other hand, the recent reports of the results of the randomized trials on anaplastic oligodendroglioma (AO) and elderly glioblastoma (GB) have significant impact on clinical practice. In this review, we discuss the risks and benefits of the two new drugs, as well as the updated standard treatment for AO and elderly GB. Local chemotherapy with BCNU wafers offered a survival benefit to patients with recurrent as well as newly diagnosed malignant gliomas. BEV monotherapy was associated with a decrease in tumor volume as defined by contrast enhancement in the majority of the recurrent glioblastomas. The addition of BEV to radiotherapy (RT)/ temozolomide (TMZ) for newly diagnosed glioblastoma patients improved progression-free survival (PFS) but not overall survival (OS). The analyses of two phase rn clinical trials from the 1990’s with long-term follow-up have shown that early administration of chemotherapy improved the OS of patients with anaplastic oligodendro-glial tumors harboring a 1p19q co-deletion. Moreover, two phase rn clinical trials with elderly glioblastoma patients have shown that MGMT promoter methylation predicts increased OS for patients treated with TMZ monotherapy. The recent approval of new drugs are encouraging. However, to fully benefit from these drugs, neuro-oncologists should correctly understand the results of the relevant clinical trials and be well aware of the possible risks. Current evidence suggests that molecular studies should be included in routine diagnostic procedures.