Mayo Clinic calls out need for aggressive glioblastoma treatment

Despite improvements in median and short-term survival rates in glioblastoma, the percentage of patients achieving five-year survival remains low, according to new Mayo Clinic research.

A study published in July 2019 in Mayo Clinic Proceedings called for aggressive treatments to be considered for all patients with glioblastoma after finding that little has changed in terms of five-year survival — only 5.5% of patients live for five years after diagnosis.

Gliomas represent about 75% of malignant primary brain tumors, according to previous studies. Glioblastoma, a grade 4 glioma, is among the most aggressive forms of cancer and the most common brain tumor in adults.

The retrospective analysis of 48,652 glioblastoma cases in the National Cancer Database from January 2004 through December 2009 found that 2,249 patients survived at least five years after diagnosis. Among those who reached five-year survival, the median length of survival was 88 months, or about 7.5 years. Patients who did not survive five years had a median survival of just seven months.

"The introduction of chemotherapy in the treatment of glioblastoma was revolutionary, although this research suggests that chemotherapy serves more as a temporizing measure against disease recurrence and death," said Daniel M. Trifiletti, M.D., a radiation oncologist at Mayo Clinic in Florida and senior author of the published study. "Considerable work needs to be done to provide hope for patients with glioblastoma."

The study involved oncology, radiation and biomedical statistics researchers from Mayo Clinic's Florida and Minnesota campuses and from East Tennessee State University.

According to the study, factors associated with five-year survival included age, race and gender. Patients who achieved five-year survival were relatively younger adults, female and nonwhite. Other factors included having generally good health, higher median income, tumors that were on the left side of the brain or outside the brainstem, and treatment with radiotherapy. Contrary to previous studies, this study found that tumor size didn't seem to significantly affect the odds of long-term survival.

The findings suggest that aggressive treatments that focus on long-term survival will be needed. "Although it is uncertain how this may be achieved, it likely will require novel and radical approaches to treatment of the disease," Dr. Trifiletti said. The study recommends that nearly all patients should be offered enrollment in a clinical trial.

Several studies are already underway to test promising new surgeries, radiation techniques and drug therapies. "To me, the most exciting area is in cellular therapy," Dr. Trifiletti said. "In my lab, I am evaluating the possibility of using targeted cellular therapy as an agent that can synergize with existing therapies, including radiation."

Dr. Trifiletti discloses that he has received research grants from Novocure, and that Paul D. Brown, M.D., a radiation oncologist at Mayo Clinic in Rochester, Minnesota, and study co-author, serves on the data and safety monitoring panel of IQVIA Biotech. The other authors report no competing interests.

Related

• Daniel M. Trifiletti, M.D.
• Paul D. Brown, M.D.
• Glioblastoma
• Progress Toward Long-Term Survivors of Glioblastoma

This article was originally published in Forefront, Mayo Clinic Cancer Center's online magazine, which ceased publication in December 2020.