What is the prognosis for a patient with Grade 4 (G4) glioblastoma?

From the Guidelines

The prognosis for a patient with Grade 4 (G4) glioblastoma is generally poor, with a median survival of approximately 15-18 months, despite aggressive treatment with maximal safe surgical resection, concurrent radiation therapy, and temozolomide chemotherapy.

Key Factors Influencing Prognosis

• Tumor grade and histology are significant prognostic factors, with glioblastoma carrying the worst prognosis 1
• Performance status and neurological function are also crucial in determining the prognosis, with better outcomes observed in patients with good performance status and intact neurological function 1
• Age is another important factor, with patients under 50 years having a more favorable prognosis 1
• The extent of tumor resection is a prognostic factor, with maximal tumor resection associated with better outcomes 1

Treatment and Management

• Standard treatment involves maximal safe surgical resection followed by concurrent radiation therapy (60 Gy in 30 fractions) with temozolomide chemotherapy (75 mg/m² daily during radiation), then adjuvant temozolomide (150-200 mg/m² for 5 days every 28 days) for 6-12 cycles 1
• For elderly patients or those with poor performance status, hypofractionated radiation therapy may be used 1
• Tumor treating fields (TTFields) can be added after radiation to improve survival
• MGMT promoter methylation status helps predict response to temozolomide 1
• Supportive care includes dexamethasone for cerebral edema and antiepileptic drugs for patients with seizures

Recurrence and Further Management

• Recurrence is nearly universal, with options including re-resection, re-irradiation, bevacizumab, or enrollment in clinical trials
• The choice of treatment for recurrence depends on various factors, including the patient's performance status, extent of recurrence, and previous treatments 1

From the Research

Prognosis for Grade 4 Glioblastoma

• The prognosis for a patient with Grade 4 (G4) glioblastoma is generally poor, with a high risk of recurrent disease and a dismal outcome despite intensive treatment 2, 3.
• The current standard of care for newly diagnosed glioblastoma involves maximally safe surgical resection, followed by radiotherapy and temozolomide chemotherapy, and then adjuvant temozolomide for 6 months 4.
• The median overall survival for patients with newly diagnosed glioblastoma is approximately 14.6-16 months, and the median progression-free survival is around 9.6 months 3, 4.
• Available treatments for recurrent glioblastoma include nitrosureas, bevacizumab, and temozolomide rechallenge, as well as tumor treating fields (TTF) devices 5.
• TTF devices have been shown to improve overall survival and progression-free survival in comparison to the current standard of care 4.

Treatment Options

• Standard therapies for glioblastoma include surgical resection, radiation therapy, and systemic chemotherapy 5.
• Bevacizumab may increase response rates to chemotherapy in the recurrent treatment setting of glioblastoma, but its use in combination with radiotherapy and temozolomide does not favor a neoadjuvant approach 3.
• Enrollment in clinical trials is encouraged for both newly diagnosed and recurrent glioblastoma patients, as many agents are being evaluated in clinical trials, including novel targeted therapies, novel chemotherapies, and immunotherapies 5, 6.