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Very interesting question. The clinical trial for Regorafenib in recurrent gbm showed a small benefit over Lomustine. However, the control group of Lomustine did terrible compared to the large trial testing Lomustine. In the Regorafenib trial, the control group of Lomustine had 5.6 months of overall survival. In the Lomustine trial, the same type of patients had a median overall survival of 8.6–9.8 months. The Regorafenin group had 7.4 months. So although Regorafenib did better than the randomized control group it did not do as well as the Lomustine in the Lomustine trial.
However, reports from real world use of the drug came in that said almost all patients get severe side effects and they did not see the benefit seen in the trial. So what do you do?
Obviously more research needs to be done hopefully to find if there are biomarkers that would push you toward Lomustine, Regorafenib or the combination. Perhaps the best way would be for having all patients be followed in a registry so we can see how it works in the real world and correlate with biomarkers. As in our brain tumor virtual trial project or our new Excelsior registry https://clinicaltrials.gov/ct2/show/NCT03793088?term=musella&draw=2&rank=4