Neurologic Manifestations of Glioblastoma Multiforme Medication

Updated: Nov 07, 2021
  • Author: Gaurav Gupta, MD, FAANS, FACS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Medication

Medication Summary

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

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Alkylating agents

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)

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)

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.

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Vascular endothelial growth factor inhibitors

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)

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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