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Journal of Cancer Research and Clinical... Apr 2001The treatment of malignant glioma remains problematic. Surgical removal followed by external beam irradiation represents a standard treatment that has demonstrated a... (Review)
Review
The treatment of malignant glioma remains problematic. Surgical removal followed by external beam irradiation represents a standard treatment that has demonstrated a prolonged time to progression and survival. However, the capacity to locally invade normal brain invariably leads to formation of a recurrent tumor most often immediately adjacent to the site of resection. This clinical everyday experience prompts the hypothesis that improved local control of the tumor may translate into a delayed time to progression and possibly survival, specifically because systemic chemotherapy for most of these tumors has failed to significantly improve survival. Local treatment strategies including chemotherapy, gene therapy, and immunotherapy are rapidly developing and progressing to clinical trials. Several theoretical considerations suggest that these approaches may be promising in the treatment of brain tumors.
Topics: Genetic Therapy; Glioma; Humans; Immunotherapy; Magnetic Resonance Imaging
PubMed: 11315255
DOI: 10.1007/s004320000188 -
Gan To Kagaku Ryoho. Cancer &... Feb 2014Glioblastoma(GBM)is the most malignant and frequent primary brain tumor. The current standard of care consists of maximum safe resection and radiotherapy with... (Review)
Review
Glioblastoma(GBM)is the most malignant and frequent primary brain tumor. The current standard of care consists of maximum safe resection and radiotherapy with concomitant and subsequent temozolomide(TMZ)treatment. With this treatment plan, the prognosis of patients with GBM remains dismal, with a 5-year survival rate of<10%; thus development of effective, novel therapies is needed. Bevacizumab(Bev, Avastin®)is a humanized monoclonal antibody against vascular endothelial growth factor(VEGF), one of the major potent angiogenic factors for the growth of human cancers, including GBM. Bev has been shown to effectively shrink enhancing lesions of recurrent GBM and decrease symptom burden and brain edema. These positive results led to its approval for malignant glioma treatment in June 2013 in Japan. Two double-blind, placebo-controlled, randomized phase III studies of Bev in newly diagnosed GBM were conducted to verify its efficacy as a first-line therapy used in combination with TMZ. The results, which were reported at the American Society for Clinical Oncology(ASCO)meeting in June 2013, failed to show an increase in overall survival, despite prolongation in progression-free survival. These results led to many unsolved issues regarding the use of Bev for the treatment of GBM. We discuss these problems in this paper and highlight our institutional experience with Bev monotherapy for recurrent high-grade gliomas.
Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal; Clinical Trials as Topic; Glioma; Humans; Molecular Targeted Therapy
PubMed: 24743191
DOI: No ID Found -
Japanese Journal of Clinical Oncology May 2022Although boron neutron capture therapy has shown excellent survival data, previous studies have shown an increase in radiation necrosis against recurrent malignant...
BACKGROUND
Although boron neutron capture therapy has shown excellent survival data, previous studies have shown an increase in radiation necrosis against recurrent malignant glioma. Herein, we proposed that bevacizumab may reduce radiation injury from boron neutron capture therapy by re-irradiation. We evaluated the efficacy and safety of a boron neutron capture therapy and add-on bevacizumab combination therapy in patients with recurrent malignant glioma.
METHODS
Patients with recurrent malignant glioma were treated with reactor-based boron neutron capture therapy. Treatment with bevacizumab (10 mg/kg) was initiated 1-4 weeks after boron neutron capture therapy and was administered every 2-3 weeks until disease progression. Initially diagnosed glioblastomas were categorized as primary glioblastoma, whereas other forms of malignant glioma were categorized as non-primary glioblastoma.
RESULTS
Twenty-five patients (14 with primary glioblastoma and 11 with non-primary glioblastoma) were treated with boron neutron capture therapy and add-on bevacizumab. The 1-year survival rate for primary glioblastoma and non-primary glioblastoma was 63.5% (95% confidence interval: 33.1-83.0) and 81.8% (95% confidence interval: 44.7-95.1), respectively. The median overall survival was 21.4 months (95% confidence interval: 7.0-36.7) and 73.6 months (95% confidence interval: 11.4-77.2) for primary glioblastoma and non-primary glioblastoma, respectively. The median progression-free survival was 8.3 months (95% confidence interval: 4.2-12.1) and 15.6 months (95% confidence interval: 3.1-29.8) for primary glioblastoma and non-primary glioblastoma, respectively. Neither pseudoprogression nor radiation necrosis were identified during bevacizumab treatment. Alopecia occurred in all patients. Six patients experienced adverse events ≥grade 3.
CONCLUSIONS
Boron neutron capture therapy and add-on bevacizumab provided a long overall survival and a long progression-free survival in recurrent malignant glioma compared with previous studies on boron neutron capture therapy alone. The add-on bevacizumab may reduce the detrimental effects of boron neutron capture therapy, including pseudoprogression and radiation necrosis. Further studies of the combination therapy with a larger sample size and a randomized controlled design are warranted.
Topics: Bevacizumab; Boron Neutron Capture Therapy; Brain Neoplasms; Glioblastoma; Glioma; Humans; Necrosis; Neoplasm Recurrence, Local; Radiation Injuries
PubMed: 35079791
DOI: 10.1093/jjco/hyac004 -
Neuron Jun 2008Several years ago, the discovery of a highly tumorigenic subpopulation of stem-like cells embedded within fresh surgical isolates of malignant gliomas lent support to a... (Review)
Review
Several years ago, the discovery of a highly tumorigenic subpopulation of stem-like cells embedded within fresh surgical isolates of malignant gliomas lent support to a new paradigm in cancer biology--the cancer stem cell hypothesis. At the same time, these "glioma stem cells" seemed to resolve a long-standing conundrum on the cell of origin for primary cancers of the brain. However, central tenets of the cancer stem cell hypothesis have recently been challenged, and the cellular origins of stem-like cells within malignant glioma are still contended. Here, we summarize the issues that are still in play with respect to the cancer stem cell hypothesis, and we revisit the developmental origins of malignant glioma. Do glioma stem cells arise from developmentally stalled neural progenitors or from dedifferentiated astrocytes? Five separate predictions of a neural progenitor cell of origin are put to the test.
Topics: Animals; Brain Neoplasms; Glioma; Humans; Neoplastic Stem Cells; Neurons; Stem Cells
PubMed: 18579075
DOI: 10.1016/j.neuron.2008.05.031 -
Targeted Oncology Sep 2010
Topics: Animals; Antineoplastic Agents; Brain Neoplasms; Drugs, Investigational; Glioma; Humans
PubMed: 20827575
DOI: 10.1007/s11523-010-0152-7 -
Neuro-oncology May 2010
Topics: Brain Neoplasms; Glioma; Humans; Tumor Suppressor Protein p53
PubMed: 20406892
DOI: 10.1093/neuonc/noq037 -
Journal of Neuro-oncology May 2011The initial management of patients with malignant gliomas depends on accurate histologic diagnosis which, in turn, directs appropriate treatment planning. However, the... (Review)
Review
The initial management of patients with malignant gliomas depends on accurate histologic diagnosis which, in turn, directs appropriate treatment planning. However, the diagnosis of recurrent disease is often based solely on radiological data which can occasionally be misinterpreted as showing recurrent tumor. Lack of awareness of conditions that mimic recurrent tumor and potentially confound radiological diagnosis can lead to inappropriate therapeutic decisions. We report the case of a patient whose imaging studies suggested recurrence of malignant glioma; however, surgical resection of the lesion guided by MRI scans resulted in the correct diagnosis of papillary endothelial hyperplasia and led to appropriate management of this condition that mimicked tumor recurrence. In this report, we provide a comprehensive review of this rare entity and emphasize the importance of adequately pursuing appropriate diagnostic considerations prior to making definitive treatment decisions.
Topics: Adult; Brain Neoplasms; Diagnosis, Differential; Endothelium; Female; Glioma; Humans; Hyperplasia; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Vascular Neoplasms
PubMed: 20740304
DOI: 10.1007/s11060-010-0338-y -
Neurologia Medico-chirurgica Sep 2021Clinical trial data of Carmustine implant (Gliadel Wafer) in Japanese patients with malignant glioma are limited; thus, we conducted a postmarketing surveillance study...
Clinical trial data of Carmustine implant (Gliadel Wafer) in Japanese patients with malignant glioma are limited; thus, we conducted a postmarketing surveillance study to evaluate the safety of Gliadel in real-world clinical practice in Japan. In this postmarketing surveillance study, all patients who received Gliadel placement for malignant glioma surgeries from its market launch (January 9, 2013) to July 10, 2013 were enrolled from 229 institutions using a central registration system. Up to eight wafers of Gliadel (containing 61.6 mg of carmustine) were used to cover the site of brain tumor resection intraoperatively according to the size and shape of the tumor resection cavity. The observation period lasted 3 months after Gliadel placement. Patients were followed up for 1 year postoperatively. Safety was assessed by the incidence of adverse events (AEs) and adverse drug reactions (ADRs). In total, 558 patients were included. Most patients (66.7%) received eight Gliadel wafers. The percentage of patients with ADRs was 35.7% (365 ADR episodes in 199 patients). Of the AEs of special interest, the most common were cerebral edema (22.2%, 124/558 patients), convulsion (9.9%, 55/558 patients), impaired healing (4.8%, 27/558 patients), and infection (3.4%, 19/558 patients). This first all-case postmarketing surveillance report of the safety of Gliadel in real-world clinical practice in Japan suggests that the risk of toxicity with Gliadel placement is relatively tolerable. The survival benefits of Gliadel placement should be evaluated and considered carefully by the clinician taking into account possible toxicities.
Topics: Antineoplastic Agents, Alkylating; Brain Neoplasms; Carmustine; Decanoic Acids; Glioma; Humans; Japan; Polyesters; Treatment Outcome
PubMed: 34092748
DOI: 10.2176/nmc.oa.2021-0024 -
CNS Oncology Sep 2012
Topics: Biomarkers, Tumor; Brain Neoplasms; Clinical Trials as Topic; Glioma; Humans; Precision Medicine
PubMed: 25054291
DOI: 10.2217/cns.12.10 -
Oncology Nursing Forum Sep 2009
Review
Topics: Antineoplastic Agents; Brain Neoplasms; Glioma; Humans; Incidence; Neoplasm Recurrence, Local; Neoplasm Staging; Neurosurgical Procedures; Occupational Exposure; Oncology Nursing; Prognosis; Radiotherapy, Adjuvant; Risk Factors; United States
PubMed: 19726382
DOI: 10.1188/09.ONF.E232-E240