Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

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OBJECTIVE

Data on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.

METHODS

The authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.

RESULTS

One hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3–8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5–5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17–2.15; p = 0.002).

CONCLUSIONS

Treatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.

ABBREVIATIONS EORTC = European Organisation for Research and Treatment of Cancer; GBM = glioblastoma; KPS = Karnofsky Performance Scale; MGMT = O6-methylguanine-DNA methyltransferase; OS = overall survival; PFS = progression-free survival; QOL = quality of life; SaP = survival after progression.
Article Information

Contributor Notes

Correspondence Pantelis Stavrinou: University Hospital of Cologne, Germany. pantelis.stavrinou@uk-koeln.de.INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.7.JNS18228.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Bloch OHan SJCha SSun MZAghi MKMcDermott MW: Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg 117:103210382012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Chinot OLWick WMason WHenriksson RSaran FNishikawa R: Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med 370:7097222014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Combs SEDebus JSchulz-Ertner D: Radiotherapeutic alternatives for previously irradiated recurrent gliomas. BMC Cancer 7:1672007

  • 4

    Combs SEEdler LRausch RWelzel TWick WDebus J: Generation and validation of a prognostic score to predict outcome after re-irradiation of recurrent glioma. Acta Oncol 52:1471522013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Delgado-Fernandez JGarcia-Pallero MABlasco GPenanes JRGil-Simoes RPulido P: Usefulness of reintervention in recurrent glioblastoma: an indispensable weapon for increasing survival. World Neurosurg 108:6106172017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Diebold GDucray FHenaine AMFrappaz DGuyotat JCartalat-Carel S: Management of glioblastoma: comparison of clinical practices and cost-effectiveness in two cohorts of patients (2008 versus 2004) diagnosed in a French university hospital. J Clin Pharm Ther 39:6426482014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Dincoglan FBeyzadeoglu MSager ODemiral SGamsiz HUysal B: Management of patients with recurrent glioblastoma using hypofractionated stereotactic radiotherapy. Tumori 101:1791842015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Fietkau RPutz FLahmer GSemrau SBuslei R: Can MGMT promoter methylation status be used as a prognostic and predictive marker for glioblastoma multiforme at the present time? A word of caution. Strahlenther Onkol 189:9939952013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Fine HADear KBLoeffler JSBlack PMCanellos GP: Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 71:258525971993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Guyotat JSignorelli FFrappaz DMadarassy GRicci ACBret P: Is reoperation for recurrence of glioblastoma justified? Oncol Rep 7:8999042000

  • 11

    Kim HRKim KHKong DSSeol HJNam DHLim DH: Outcome of salvage treatment for recurrent glioblastoma. J Clin Neurosci 22:4684732015

  • 12

    Louis DNOhgaki HWiestler ODCavenee WKBurger PCJouvet A: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:971092007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    McNamara MGLwin ZJiang HTempleton AJZadeh GBernstein M: Factors impacting survival following second surgery in patients with glioblastoma in the temozolomide treatment era, incorporating neutrophil/lymphocyte ratio and time to first progression. J Neurooncol 117:1471522014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Nava FTramacere IFittipaldo ABruzzone MGDimeco FFariselli L: Survival effect of first- and second-line treatments for patients with primary glioblastoma: a cohort study from a prospective registry, 1997–2010. Neuro Oncol 16:7197272014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Parakh SThursfield VCher LDally MDrummond KMurphy M: Recurrent glioblastoma: Current patterns of care in an Australian population. J Clin Neurosci 24:78822016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Park JKHodges TArko LShen MDello Iacono DMcNabb A: Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 28:383838432010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ryu SBuatti JMMorris AKalkanis SNRyken TCOlson JJ: The role of radiotherapy in the management of progressive glioblastoma: a systematic review and evidence-based clinical practice guideline. J Neurooncol 118:4894992014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Seystahl KGramatzki DRoth PWeller M: Pharmacotherapies for the treatment of glioblastoma—current evidence and perspectives. Expert Opin Pharmacother 17:125912702016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Signorovitch JLi NOhashi EDastani HShaw JOrsini L: Overall survival (OS), quality of life (QOL), and neurocognitive function (NF) in recurrent glioblastoma multiforme (GBM): a systematic literature review. Value Health 18:A4332015 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 20

    Steffens RSemrau SLahmer GPutz FLettmaier SEyüpoglu I: Recurrent glioblastoma: who receives tumor specific treatment and how often? J Neurooncol 128:85922016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Stupp RHegi MEMason WPvan den Bent MJTaphoorn MJJanzer RC: Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:4594662009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Stupp RMason WPvan den Bent MJWeller MFisher BTaphoorn MJ: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:9879962005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Stupp RTaillibert SKanner AAKesari SSteinberg DMToms SA: Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: a randomized clinical trial. JAMA 314:253525432015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Suchorska BWeller MTabatabai GSenft CHau PSabel MC: Complete resection of contrast-enhancing tumor volume is associated with improved survival in recurrent glioblastoma—results from the DIRECTOR trial. Neuro Oncol 18:5495562016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Taal WOosterkamp HMWalenkamp AMDubbink HJBeerepoot LVHanse MC: Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncol 15:9439532014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Weller MCloughesy TPerry JRWick W: Standards of care for treatment of recurrent glioblastoma—are we there yet? Neuro Oncol 15:4272013

  • 27

    Weller Mvan den Bent MTonn JCStupp RPreusser MCohen-Jonathan-Moyal E: European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol 18:e315e3292017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Wen PYMacdonald DRReardon DACloughesy TFSorenson AGGalanis E: Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:196319722010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Woernle CMPéus DHofer SRushing EJHeld UBozinov O: Efficacy of surgery and further treatment of progressive glioblastoma. World Neurosurg 84:3013072015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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