Treatment of Recurrent or Progressive Glioblastoma Demonstrated on Neuroimaging

Situation

This protocol applies when glioblastoma has been confirmed as recurrent or progressive on neuroimaging. Management at this stage is less well-established than at initial diagnosis and results in considerably more variability across treatment decisions.

Approach

Treatment is individualized. The preferred starting point, for eligible patients, is enrollment in a clinical trial. Beyond that, the approach is shaped by factors including performance status, tumor resectability, time elapsed since prior radiation, and tumor molecular profile — with systemic therapy options varying based on MGMT methylation status and the presence of specific targetable alterations.

Full regimen details, decision criteria, and sequencing are in the structured protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/neuonc/noaf177

The management of recurrent glioblastoma is less well-established resulting in more variability (Figure 9).
For patients with good performance status, clinical trials are recommended.
Systemic therapy is recommended for most patients with recurrent glioblastoma who are fit enough for treatment.
Reirradiation might be an option in select cases, especially if more than 6–12 months have passed since the initial course of radiation, or if re-irradiation trials are available.
Only a small percentage of glioblastomas harbor mutations that confer sensitivity to targeted therapies such as dabrafenib/trametinib for BRAF V600E mutations, larotrectinib for NTRK fusions, and erdafitinib, futibatinib and pemigatinib for specific FGFR alterations, including FGFR3-TACC3 fusions.

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