Current Therapies and Future Directions in Treatment of Glioblastoma

Abstract

The current standard of care for initial treatment of adults with newly diagnosed glioblastoma (GBM) constitutes maximal safe resection followed by concurrent chemoradiation therapy and adjuvant chemotherapy with temozolomide; recent studies have shown improvement in survival benefit with the addition of tumor treatment fields (TTF) to this regimen. For recurrent disease, lomustine and bevacizumab yield benefit in progression-free survival but not in overall survival. Recent advances in the understanding of the biology of GBM have provided the basis for new therapeutic approaches against these tumors. However, the initial promise of agents targeted against specific pathways active in GBM failed to yield the expected improvement in outcome likely due to intra- and inter-tumoral heterogeneity. Current efforts are focused on immunotherapy, biological agents and combination targeted therapies to overcome these challenges. Additionally, ongoing research to better understand the basis of tumor heterogeneity is expected to provide new insights that can help broadly target GBMs that can translate into improved survival and quality of life for these patients. This review provides an outline of current treatments and examines the newer approaches that bear promise to provide a meaningful improvement in outcome of patients with GBM.