New adjuvant chemotherapy for glioblastoma

Cormustine wafers (Gliodel (R)) and temozolomide (Temodol (R)) were recently approved for initial management of glioblastoma. Gliodel (R) is a polymer wafer containing carmustine. These wafers are designed to be placed in the surgical cavity after glioblastoma resection to deliver local chemotherapy This treatment is intended for tumors for which gross total resection is possible. Temozolomide is administered concomitantly with radiotherapy for six weeks followed by six cycles of adjuvant temozolomide (EORTC 26981, also known as "Stupp's protocol"). Temozolomide administered according to this protocol produced a median survival benefit of 2 months in glioblastomas, and carmustine a similar benefit in high-grade gliomas. The two-year survival rate was 26.5% with radiotherapy plus temozolomide compared with 10.4% with radiotherapy alone. In patients with complete resection, two-year survival reached 38%. These two new treatments ore essentially intended for patients younger than 70 years and with a Karnofsky index > 70. Ongoing studies are evaluating the possible value of combining these two treatments.