The road towards stratified care for patients with glioblastoma

Extensive efforts are currently underway to define biological markers as the basis for treatment selection for patients with glioblastomas, delegates heard in an ESMO 2012 symposium dedicated to exploring new avenues in molecular neuro-oncology diagnosis and treatment.

Dr Michael Weller, from University Hospital, Zurich, Switzerland, advised that a recent clinical issue has been the growing population of elderly patients with glioblastoma, where the combination of radiochemotherapy doesn’t appear to be superior to monotherapy and may be less well tolerated than either radiotherapy or chemotherapy alone. Given this situation, Dr Weller highlighted the need to identify biomarkers to help stratify patient care.

It has already been shown that glioblastoma patients with promoter methylation of the 06-methylguanine methyltransferase (MGMT) gene derive greater benefits from alkylating agent chemotherapy. MGMT promoter methylation may therefore assume a particularly important role as a predictive biomarker among elderly glioblastoma patients.

Although results from registration trials for two anti-angiogenic compounds are still awaited, biomarkers to indicate which patients might derive most benefit from anti-vascular endothelial growth factor (VEGF) therapies have not been introduced into the clinic. However, it may be possible to use positron emission tomography (PET) for the detection of avb3/5 integrins in order to select patients for anti-integrin/anti-angiogenic therapy.

Screening for the epidermal growth factor receptor mutation, EGFRvIII, is also being explored as a biomarker for selecting patients for vaccination in two randomized clinical trials. “It’s to be hoped that these and other ongoing clinical trials may enrich the repertoire of criteria for clinical decision making in the very near future,” concluded Dr Weller.