From the Guidelines
The standard treatment approach for glioma typically involves a multimodal strategy tailored to the tumor's grade, location, and the patient's overall health, with surgical resection, adjuvant radiation therapy, and concurrent temozolomide chemotherapy being the cornerstone of treatment for high-grade gliomas like glioblastoma.
Key Considerations
- Initial management usually begins with surgical resection to remove as much tumor as possible while preserving neurological function 1.
- For high-grade gliomas like glioblastoma, the standard regimen includes adjuvant radiation therapy (typically 60 Gy delivered in 30 fractions over 6 weeks) combined with concurrent temozolomide chemotherapy (75 mg/m² daily during radiation), followed by maintenance temozolomide (150-200 mg/m² for 5 days every 28-day cycle for 6-12 cycles) 1.
- For lower-grade gliomas, treatment may be less aggressive, sometimes involving observation after surgery or radiation alone, though chemotherapy is increasingly used for these cases too.
- Supportive medications often include dexamethasone (starting at 4-16 mg/day in divided doses) to control cerebral edema, and antiepileptic drugs like levetiracetam (500-1500 mg twice daily) for seizure management.
Treatment Approach by Patient Group
- For patients younger than 70 years of age with good performance status, the optimal dose fractionation schedule for external beam radiation therapy after resection or biopsy is 60 Gy in 2-Gy fractions delivered over 6 weeks 1.
- Among elderly patients (≥ 70 years old) with fair to good performance status, hypofractionated radiotherapy (eg, 40 Gy in 15 fractions over 3 weeks) is recommended, with the option of adding concurrent and adjuvant temozolomide for selected patients 1.
- Temozolomide monotherapy is an efficacious alternative for elderly patients with MGMT promoter methylation, but not recommended as first-line therapy for patients with unmethylated MGMT promoters 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Newly Diagnosed Glioblastoma Multiforme Temozolomide capsules are indicated for the treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and then as maintenance treatment.
The standard treatment approach for patients diagnosed with glioblastoma multiforme, a type of glioma, is temozolomide concomitantly with radiotherapy, followed by maintenance treatment with temozolomide 2.
- Key points:
- Temozolomide is used in combination with radiotherapy for the initial treatment of glioblastoma multiforme.
- After the initial treatment phase, temozolomide is continued as maintenance treatment.
- This treatment approach is specifically indicated for adult patients with newly diagnosed glioblastoma multiforme.
From the Research
Standard Treatment Approach for Glioma
The standard treatment approach for patients diagnosed with glioma involves a combination of surgical resection, radiation therapy, and chemotherapy.
- Maximally safe surgical resection is typically the first step in treatment, followed by concurrent radiation therapy (RT) and temozolomide (TMZ) for 6 weeks, then adjuvant TMZ for 6 months 3.
- Radiation therapy with concomitant and adjuvant temozolomide chemotherapy is the current standard of care for patients with newly diagnosed glioblastoma up to age 70 4.
- For elderly patients (≥ 65 years), a new standard of care has been adopted, which involves a short course of RT and TMZ 4.
Treatment Options
There are several FDA-approved treatments for high-grade gliomas, including:
- Lomustine
- Intravenous carmustine
- Carmustine wafer implants
- Bevacizumab (BVZ)
- Tumor treatment fields (TTFields) 3
- TTFields has been shown to improve overall survival and progression-free survival compared to the current standard of care 3.
Radiation Therapy
Radiation therapy plays an integral role in the treatment of glioblastoma, and the optimal dose-fractionation schedule and target volumes may vary depending on patient characteristics such as age and performance status 5.
- Conventionally fractionated radiation therapy (e.g., 60 Gy in 2-Gy fractions) with concurrent and adjuvant temozolomide is recommended for patients with reasonable performance status up to 70 years of age 5.
- Hypofractionated radiation therapy (e.g., 40 Gy in 2.66-Gy fractions) may be considered for elderly patients (≥ 70 years of age) with reasonable performance status 5.