Second-Line Chemotherapy in Recurrent Glioblastoma - Still Controversial

Abstract

studies, providing an important benchmark for future trials. Data about the combination of bevacizumab and lomustine were also considered worthy of further investigation in a phase III study, and the EORTC re-designed a randomized study with the aim to compare lomustine alone versus a combination of lomustine and bevacizumab. The results of the study of Carvalho et al. [1] are in line with what was obtained in the previous bevacizumab studies, and they suggest that this antiangiogenic agent could be a potential alternative to chemotherapy in recurrent disease. Despite the increasing scientific knowledge about the use of bevacizumab in glioblastoma treatment some aspects about this agent still remain controversial. For instance, the updated Response Assessment in Neuro-Oncology (RANO) criteria [8] have not yet been prospectively validated, and disease assessment with bevacizumab remains challenging: neuroradiological predictors of outcomes are needed, as well as characterization of molecular profiles that could help clinicians in selection of possible responders amongst patients. While waiting for studies that could clarify these aspects, clinical factors may help physicians choosing the best treatment: patients’ age [6], comorbidities, and previous toxicities to temozolomide may help in the decision for the best therapy.