Abstract
Glioblastoma multiforme (GBM), the most common malignant brain tumor, universally carries a poor prognosis. Despite aggressive multimodality treatment, the median survival is ~18–20 months, depending on molecular subgroups. A long history of observations suggests antitumor effects of bacterial infections against malignant tumors. The present review summarizes and critically analyzes the clinical data providing evidence for or against the survival benefit of post-operative bacterial infections in GBM patients. Furthermore, we explore the probable underlying mechanism(s) from basic science studies on the topic. There are plausible explanations from immunobiology for the mechanism of the “favorable effect” of bacterial infections in GBM patients. However, available clinical literature does not provide a definitive association between postoperative bacterial infection and prolonged survival in GBM patients. The presently available, single-/multi-center and national database retrospective case-control studies on the topic provide conflicting results. A prospective randomized study on the subject is clearly not possible. Immunobiology literature supports development of genetically modified bacteria as part of multimodal regimen against GBM.
Highlights
Glioblastoma multiforme (GBM), the most common malignant brain tumor, universally carries a poor prognosis [1,2,3]
It has long been speculated that postoperative bacterial infection may prolong survival in cancer patients by stimulating immune response [12]
The present review summarizes the clinical data on the role of post-operative bacterial infections on survival in GBM patients
Summary
Glioblastoma multiforme (GBM), the most common malignant brain tumor, universally carries a poor prognosis [1,2,3]. The current standard treatment for newly diagnosed GBM include maximal surgical resection, followed by radiation therapy given concomitantly with temozolomide (TMZ) followed by adjuvant TMZ chemotherapy [4,5,6]. The median survival is ∼18–20 months, depending on molecular subgroups [2, 7, 8]. Adjuvant chemo-radiation, young age, high Karnofsky Performance Score (KPS), and DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) promoter hypermethylation are factors associated with improved survival [9,10,11]
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