Medication Summary

The goals of pharmacotherapy for glioblastoma multiforme (GBM) are to reduce morbidity and to prevent complications.

Class Summary

Alkylating agents lead to DNA double strand breaks and apoptosis.

Local chemotherapy with carmustine wafers significantly prolongs survival in patients with newly diagnosed primary malignant glioma.

Temozolomide (Temodar)

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Oral alkylating approved for newly diagnosed GBM and recurrent anaplastic astrocytomas. Converted to MTIC at physiologic pH; 100% bioavailable; approximately 35% crosses blood-brain barrier. Indicated for GBM combined with radiotherapy. Significant overall survival was demonstrated in patients treated with temozolomide and radiation compared with radiotherapy alone.

Carmustine (BiCNU, Gliadel Wafer)

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Gliadel is a small wafer that contains the chemotherapeutic drug carmustine. The wafer is designed to release the drug slowly over a period of 2-3 wk after placed in tumor bed. Up to 8 wafers are implanted in the cavity, slowly delivering carmustine directly to tumor site.

Class Summary

These are monoclonal antibodies that target the vascular endothelial growth factor (VEGF) – the principal molecule involved in angiogenesis during embryogenesis and in malignant tumors – thereby inhibiting the growth of GBM

Bevacizumab (Avastin, Mvasi, Zirabev)

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Administered as an intravenous infusion in chemotherapy day unit in the hospital. FDA-approved schedule dose for recurrent glioblastoma is 10 mg/kg every 2 weeks. However, studies show even smaller doses of 5 mg/kg every 2 weeks are also equally effective. Proteinuria and hypertension are the most frequent adverse effects of the drug.

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Media Gallery

T1-weighted axial gadolinium-enhanced MRI demonstrates an enhancing tumor of the right frontal lobe. Image courtesy of George Jallo, MD.
T2-weighted image demonstrates notable edema and midline shift. This finding is consistent with a high grade or malignant tumor. Image courtesy of George Jallo, MD.
Histopathologic slide demonstrating a glioblastoma multiforme.
Magnetic resonance spectroscopy is representative of a glioblastoma multiforme.

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Author

Gaurav Gupta, MD, FAANS, FACS Associate Professor of Neurosurgery, System Co-Director, Cerebrovascular and Endovascular Neurosurgery, Fellowship Director, Endovascular Neurosurgery Fellowship (Site), Department of Surgery, Division of Neurosurgery, Rutgers RWJ Barnabas Healthcare, Rutgers Robert Wood Johnson Medical School

Gaurav Gupta, MD, FAANS, FACS is a member of the following medical societies: American Academy of Neurology, American Association for the Advancement of Science, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, Congress of Neurological Surgeons, Facial Pain Association, Society for Neuroscience, Society of NeuroInterventional Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Fareed R Jumah, MBBS Postdoctoral Research Fellow, Department of Neurosurgery, RWJ University Hospital, Rutgers Robert Wood Johnson Medical School

Disclosure: Nothing to disclose.

Neil Majmundar, MD Resident Physician, Department of Neurological Surgery, Rutgers New Jersey Medical School

Neil Majmundar, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Bharath Raju, MBBS, MCh Postdoctoral Research Fellow, Department of Neurosurgery, RWJ University Hospital, Rutgers Robert Wood Johnson Medical School

Bharath Raju, MBBS, MCh is a member of the following medical societies: AOSpine, Bangalore Neurological Society, European Association of Neurosurgical Societies, Neurological Society of India, Neurotrauma Society of India

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge C Kattah, MD Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

ABM Salah Uddin, MD Private Practice, Norwood Neurology; Consulting Staff, Department of Neurology, St Vincent's Hospital

ABM Salah Uddin, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Medical Association

Disclosure: Nothing to disclose.

Tambi Jarmi, MD Resident Physician, Department of Internal Medicine, Carraway Methodist Medical Center

Tambi Jarmi, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Subramanian Hariharan, MD, to the development and writing of this article.