Dramatic response to regorafenib in early glioblastoma progression: case report and review of the literature

BACKGROUND: Glioblastoma (GBM) is a highly lethal disease despite integrat-ed treatment comprising radiotherapy plus con-comitant and adjuvant temozolomide, with a me-dian overall survival of less than 15 months. For recurrent glioblastoma, there is yet no standard therapy, considering that Bevacizumab have failed to improve overall survival (OS) while re-gorafenib had a little benefit over standard che- motherapy. In addition, the disease control rate is almost exclusively stability, with a poor objec-tive response rate. CASE REPORT: Here we present a case of rap-id response to regorafenib in early glioblastoma progression at the end of adjuvant radiothera-py: after a single cycle of regorafenib the patient observed an impressive improvement in clini-cal condition, disappearance of headaches and a clear reduction of neoplastic tissue in MRI. A brief review about new radiological patterns in Magnetic Resonance Imaging (MRI) related to the introduction in clinical practice of antiangio-genic drugs and tyrosine kinase inhibitors has also been carried out. CONCLUSIONS: Regorafenib was certainly a first turning point in the second-line treat- ment of GBM, showing longer response rates and mostly disease stability than bevacizum-ab. A switch-maintenance strategy with tyro-sine kinase inhibitors may represent a valid sec-ond-line therapeutic option.