Phase II trial of sunitinib for recurrent and progressive atypical and anaplastic meningioma
Sunitinib is an oral targeted therapy approved to treat cancer of the stomach and pancreas, so it is easily available. The 6 month progression free survival rate was 42%, which is much better than anything I have seen for this type of tumor. The overall survival rates are still not good enough but perhaps this may become another tool to use as part of a comprehensive treatment plan that does much better.
EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma This is the treatment guidelines from the European Association for Neuro-Oncology Task Force on Malignant Glioma. I completely disagree with them.
For young (up to 70 years old) newly diagnosed Glioblastoma patients, they say the treatment should be: Surgery (resection or biopsy), followed by radiotherapy with concurrent Temozolomide, followed by 6 months of Temozolomide. For recurrent, they say more surgery, more radiation, more chemotherapy or Avastin.
For older patients, they say radiation is optional based on MGMT and performance status.
Here in the USA, the standard treatment for newly diagnosed younger patients is a clinical trial. IF that is not possible, then the standard therapy is the same as the EANO guidelines. The EANO guidelines doesn't suggest clinical trials.
I feel clinical trials are the best way to go, but if not, I would say to follow the standard surgery, radiation and temodar, AND would also do a molecular testing such as the Foundation Medicine test. If they find any mutations in your tumor that are targeted by available drugs then I would add those drugs also.
For Recurrent GBM, here in the USA, tumor treating fields (Novocure's TTF-100A device) are approved for recurrent GBM and is in trials for newly diagnosed. Research has shown that tumor treating fields may be the best treatment for recurrent GBMs. The EANO guidelines do not mention it.
The scary part is that the European governments can use this document to justify excluding payments for treatments not recommended. That makes this a political document - based more on a cost / benefit ratio than based on what is best for the patient.
The only advantage the EANO guidelines have over the USA guidelines is the use of Gliolan, which is a dye used during surgery which allows more of the tumor to be removed safely. It is standard in Europe but not even FDA approved here in the USA yet.
