Researchers from Duke University have reported that Gliadel® (carmustine) wafers may improve survival of newly diagnosed patients with glioblastoma multiforme (GBM) treated with multimodality therapy. The details of this study appeared in the August 2009 issue of Cancer.[1]
GBM is one of the most common and fatal types of primary brain cancer. Patients with GBM typically have a poor prognosis, and treatment is usually palliative. The standard initial treatment is surgery followed by radiation therapy and chemotherapy. The median survival is approximately one year, and the three-year survival is less than 10%. Patients with a good performance status who have undergone surgery have an improved survival. Studies have shown that radiotherapy and chemotherapy improve survival regardless of other adverse risk factors. Second-line therapies are not often effective.
Carmustine (BiCNU®) is a commonly used chemotherapy agent in the treatment of gliomas. The Gliadel wafer is a solid, dime-sized implant that is comprised of carmustine. The wafer is implanted into the cavity from which the glioma was surgically removed and slowly releases carmustine into the cavity and local tissues. The Gliadel wafer is approved for up-front treatment of GBM.
The current study involved 85 newly diagnosed patients who were treated with or without Gliadel wafers. All patients were treated with radiotherapy and concurrent Temodar® (temozolomide) plus radiotherapy plus rotational chemotherapy. Patients who were treated without Gliadel wafers had a one-year survival of 69%, a two-year survival of 29%, and a median survival of 72.7 months. Patients treated with the Gliadel wafer had a one-year survival of 81%, a two-year survival of 47%, and a median survival of 89.5 weeks. These authors concluded: “Carmustine wafer with concurrent TMZ and radiation followed by rotational chemotherapy is a well tolerated, effective therapy, and has a survival benefit compared with radiation alone. Prospective randomized trials are needed to rigorously compare the carmustine wafer regimen to the Stupp and postradiation multimodality regimens.”
Comments: This study confirms other data suggesting an added benefit from the Gliadel wafer when combined with standard therapies for GBM.
Reference:
[1] Affronti ML, Heery C, Herndon JE, et al. Overall survival of newly diagnosed glioblastoma patients receiving carmustine wafers followed by radiation and concurrent temozolomide plus rotational multiagent chemotherapy. Cancer. 2009;115:3501-3511.
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