Summary
The literature review included 42 studies with 5236 people. For analysing the evidence on overall survival and progression-free survival, 11 studies were included. Lomustine (LOM; also known as CCNU) was the most common comparator and was used as the reference treatment.
The main outcomes are well described in the abstract and lay summary of the article. Here is a copy of the results:
Median OS across included studies in the network meta-analysis (NMA) ranged from 5.5 to 12.6 months and median progression-free survival (PFS) ranged from 1.5 months to 4.2 months. We found no high-certainty evidence that any treatments tested were better than lomustine.
Interventions included chemotherapy, re-operation, re-irradiation and newly developed treatments either used alone or in combination. NMA could not be performed for second or later recurrence due to insufficient data.
Survival outcomes for people with a first recurrence: We found no good evidence that any of the treatments tested were better than lomustine (also known as CCNU). Adding bevacizumab to lomustine (BEV + LOM) did not improve overall survival compared with lomustine alone. Other chemotherapy and novel agents either did not work, or the evidence on them was uncertain. Unfortunately, we did not find any studies on several commonly used treatments, such as PCV (procarbazine, CCNU, vincristine) and TMZ re-challenge, to include.
Limited evidence suggested that a second operation with or without other treatments may have survival advantages for some individuals with a first recurrence. A small study of a cannabinoid treatment suggests this merits further investigation.
The authors provide more details on the included studies, evidence on supportive care and serious adverse events for those interested. Note, studies published after 2019 were not included in this review. For additional and more recent information from our BT Online experts watch the Q & A webinar ‘High Grade Glioma – Clinical Trials’
Full text
The full text is attached below or available here.
Research publication
McBain, C., Lawrie, T. A., Rogozinska, E., Kernohan, A., Robinson, T., & Jefferies, S. (2021). Treatment options for progression or recurrence of glioblastoma: a network meta-analysis. Cochrane Database Syst Rev, 5(1), Cd013579. https://doi.org/10.1002/14651858.CD013579.pub2