New horizons in the management of glioblastoma multiforme: The end of the beginning?

Abstract

Glioblastoma multiforme is a highly invasive and aggressive brain tumour. It is the most commonly seen glioma with fast-growing features, being a devastating disease with no clear causation and no means of early detection. Less than 10% of glioblastoma multiforme patients survive more than 5 years after diagnosis. Current standard treatment includes maximal safe surgical resection and adjuvant concurrent chemo-irradiation with temozolomide followed by adjuvant temozolomide. Resistance to standard therapy still develops however, suggesting that glioblastoma multiforme cells are capable of switching their dependency from one signalling pathway to an alternative. Glioblastoma multiforme is a highly vascularised disease, in which angiogenesis plays an important role contributing to its progression and deadly course. Recently, therapies with agents targeting the vascular endothelial growth factor and vascular endothelial growth factor receptor have shown clinical benefits in patients with recurrent glioblastoma multiforme. It is indeed important to identify novel angiogenic factors that play essential roles in tumour angiogenesis and glioblastoma multiforme progression. This paper gives an overview of the management of glioblastoma multiforme including new treatments that are available, touches upon potential new therapies based on the aforesaid understanding, and discusses the promise and challenges of achieving better outcomes in this patient group. © 2010 Hong Kong College of Radiologists.