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This was an interesting study done in Taiwan where they used a rotating chemotherapy approach called BAC (bevacizumab alternating chemotherapy) in adults with recurrent high-grade glioma, including glioblastoma. The BAC regimen included 2 cycles of etoposide + carboplatin, followed by 1 cycle of cyclophosphamide + vinblastine, with bevacizumab every 4 weeks. In the patients with grade 4 gliomas, those treated with BAC lived a median of 29 months compared to 19 months with bevacizumab alone, and had 16 months of survival after recurrence versus 10 months. The benefit was especially strong in patients with MGMT-methylated tumors, who lived up to 33 months. While this was a relatively small trial from a single institution, BAC may be an option to consider for recurrent high grade glioma patients who aren’t eligible for clinical trials.