Survival, costs, and health care resource use by line of therapy in US Medicare patients with newly diagnosed glioblastoma: a retrospective observational study

Retrospective Analysis of Glioblastoma Outcomes

This retrospective mono-center study focuses on 144 cases of glioblastoma treated over a time span of 12 years in our clinic in Romania. We offer critical insight into the dreadful aspect of this tumor by highlighting the principal characteristics such as localization, the genetic information of each case, progression-free survival (PFS), and overall survival (OS). A tenth of our patients underwent a second surgical procedure, providing a comparable OS to the other part of our study group, proving that surgical treatment as salvage therapy is a viable option. Also, our research reinforces the fact that utilizing the Karnofsky Performance Scale is a great predictor of patient outcomes in glioblastoma patients. Even though radiotherapy and chemotherapy have mild effects in the context of this oncological disease, our research shows that O6-methylguanine-DNA methyltransferase (MGMT) methylation status and epidermal growth factor receptor (EGFR) amplification have an important effect on OS. Moreover, the particularity of our study, that our patients did not start adjuvant therapy right after surgery, highlighted by a low OS compared to the international literature, sheds light on the fact that chemotherapy and radiotherapy must be started right after the surgical procedure, according to the Stupp protocol. To sum up, our research takes into consideration the factors that influence patient survival and outcome in the battle against glioblastoma.

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Gliomas are a group of heterogeneous tumors that account for substantial morbidity, mortality, and costs to patients and healthcare systems globally. Survival varies considerably by grade, histology, biomarkers, and genetic alterations such as IDH mutations and MGMT promoter methylation, and treatment, but is poor for some grades and histologies, with many patients with glioblastoma surviving less than a year from diagnosis. The present review provides an introduction to glioma, including its classification, epidemiology, economic and humanistic burden, as well as treatment options. Another focus is on treatment recommendations for IDH-mutant astrocytoma, IDH-mutant oligodendroglioma, and glioblastoma, which were synthesized from recent guidelines. While recommendations are nuanced and reflect the complexity of the disease, maximum safe resection is typically the first step in treatment, followed by radiotherapy and/or chemotherapy using temozolomide or procarbazine, lomustine, and vincristine. Immunotherapies and targeted therapies currently have only a limited role due to disappointing clinical trial results, including in recurrent glioblastoma, for which the nitrosourea lomustine remains the de facto standard of care. The lack of treatment options is compounded by frequently suboptimal clinical practice, in which patients do not receive adequate therapy after resection, including delayed, shortened, or discontinued radiotherapy and chemotherapy courses due to treatment side effects. These unmet needs will require significant efforts to address, including a continued search for novel treatment options, increased awareness of clinical guidelines, improved toxicity management for chemotherapy, and the generation of additional and more robust clinical and health economic evidence.

Patterns of glioblastoma treatment and survival over a 16-years period: pooled data from the German Cancer Registries

Introduction

Glioblastoma multiforme (GBM) is a primary malignant brain tumour characterized by a very low long-term survival. The aim of this study was to analyse the distribution of treatment modalities and their effect on survival for GBM cases diagnosed in Germany between 1999 and 2014.

Methods

Cases were pooled from the German Cancer Registries with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes for GBM or giant-cell GBM. Three periods, first (January 1999–December 2005), second (January 2006–December 2010) and a third period (January 2011–December 2014) were defined. Kaplan–Meier plots with long-rank test compared median overall survival (OS) between groups. Survival differences were assessed with Cox proportional-hazards models adjusted for available confounders.

Results

In total, 40,138 adult GBM cases were analysed, with a mean age at diagnosis 64.0 ± 12.4 years. GBM was more common in men (57.3%). The median OS was 10.0 (95% CI 9.0–10.0) months. There was an increase in 2-year survival, from 16.6% in the first to 19.3% in the third period. When stratified by age group, period and treatment modalities, there was an improved median OS after 2005 due to treatment advancements. Younger age, female sex, surgical resection, use of radiotherapy and chemotherapy, were independent factors associated with better survival.

Conclusion

The inclusion of temozolomide chemotherapy has considerably improved median OS in the older age groups but had a lesser effect in the younger age group of cases. The analysis showed survival improvements for each treatment option over time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00432-021-03596-5.