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Combining Clinical and Molecular Data to Predict the Benefits of Carmustine Wafers in Newly Diagnosed High-Grade Gliomas

  • Neuro-oncology (R Soffietti, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

The purpose of this study was to retrospectively evaluate the use of carmustine wafers (CWs) in the management of high-grade gliomas (HGGs). The data from our monoinstitutional series was compared with studies reported in the literature. Special emphasis was placed on the evaluation of side effects and the analysis of extent of resection and molecular profile as risk factors.

Recent findings

The implantation of CWs into the resection cavity during HGG treatment to deliver localized chemotherapy, followed by the Stupp protocol, remains debated in a clinical setting, largely due to the lack of appropriate phase III studies. Given the high expense and poorly characterized side effects associated with CW treatment, identification of patients most likely to benefit from this therapy could be clinically relevant.

Summary

CWs may represent an effective and safe first-line treatment for patients with HGG that exhibit complete tumor resection and harboring a methylated MGMT promoter. Our investigation showed a much larger group of patients exhibiting long-term survival (> = 36 months), strongly supporting a potential survival benefit conferred via CW treatment. The pre-surgical definition of the MGMT promoter status could be of clinical use in identifying “good responders” to CW implantation.

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Acknowledgements

We thank Dr. Stefano Pizzolitto and Dr. Giovanna De Maglio for their invaluable support.

Funding

FIRB accordi di programma 2011 pr. RBAP11ETKA_007 “Nanotechnological approaches for tumor theragnostic” (APB). Programma per la Cooperazione Transfrontaliera Italia-Slovenia 2007–2013. Title: “Identificazione di nuovi marcatori di cellule staminali tumorali a scopo diagnostico e terapeutico” (MS, CDL). Project ERC- 7FP SP 2 IDEAS QUIDPROQUO G.A. n. 269051. Title: “Molecular nanotechnology for life science applications: quantitative interactomics for diagnostics, proteomics and quantitative oncology” (DC).

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Authors and Affiliations

  1. Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy

    Tamara Ius MD PhD, Giovanni Toniato MD, Giovanni Sciacca MD & Miran Skrap MD

  2. Department of Medicine, University of Udine, Udine, Italy

    Daniela Cesselli MD PhD, Miriam Isola PhD, Sara Fabbro MD, Enrico Pegolo MD, Antonio Paolo Beltrami MD PhD & Carla di Loreto MD

  3. Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy

    Giada Pauletto MD PhD

  4. Department of Oncology, Santa Maria della Misericordia University Hospital, Udine, Italy

    Simona Rizzato MD

  5. Institute of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy

    Carla di Loreto MD

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  1. Tamara Ius MD PhD
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Correspondence to Tamara Ius MD PhD.

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Ius, T., Cesselli, D., Isola, M. et al. Combining Clinical and Molecular Data to Predict the Benefits of Carmustine Wafers in Newly Diagnosed High-Grade Gliomas. Curr Treat Options Neurol 20, 3 (2018). https://doi.org/10.1007/s11940-018-0489-2

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