Authors' objectives:

The aim of this report was to assess the available evidence on the usefulness of cis-retinoic acid (CRA), also known as isotretinoin, for the treatment of glioblastoma multiforme (GBM).

Authors' results and conclusions: Only non-controlled phase II studies with 15 to 88 patients with GBM were found and included in the analysis. Two of them assess clinical response to CRA when administered as a single agent, one study evaluates its action in combination with interferon alfa-2a, two studies evaluate CRA in combination with temozolomide (a cytotoxic chemotherapy agent) and one study evaluates CRA in combination with celecoxib (a cyclooxigenase inhibitor). The two studies that evaluated CRA as a single agent for the treatment of recurrent GBM showed a six-month progression-free survival between 19% and 43% and a median survival time of 25 and 58 weeks, lower than the benefit achieved with other chemotherapy agents such as temozolomide or BCNU. In the studies where CRA was jointly administered with interferon alfa-2a or temozolomide as first line or subsequent chemotherapy for GBM, no benefit was observed when compared with historical series of patients using interferon alfa-2a or temozolomide as single agents. The addition of celecoxib to CRA for the management of recurrent GBM did not show better results than CRA alone. A guideline from the Canada Cancer Care Program was found and it concludes that it is still not clear whether chemotherapy treatments (of any kind) are beneficial for the management of glioblastoma multiforme and that new studies are required. Since the benefits of other chemotherapy regimens other than temozolomide or BCNU are unknown, the National Comprehensive Cancer Network guideline suggests the use of palliative care for the patients who did not respond to surgery, radiotherapy and these chemotherapy drugs.

Authors' recommendations: There is consensus that the management of glioblastoma multiforme consists in tumor resection plus radiotherapy. The use of chemotherapy drugs (temozolomide or BCNU) as first line or after, although frequently used, is controversial. Should the tumor be unresectable or surgery fails, and considering that the benefits of other chemotherapy regimens are controversial, some people suggest the use of palliative care in these patients. As regards the evidence found on the usefulness of CRA for the treatment of GBM, it is based on non-controlled clinical trials where the results reported are compared with historic controls which impose methodological limitations. Even in this type of studies the use of CRA as first line treatment seems to be discarded because its efficacy is lower than that of other chemotherapy treatments. As regards the hypotheses stated about the potential benefit of combining CRA with temozolomide, interferon or celecoxib to achieve synergism between the two drugs, they have been excluded because no greater benefit was demonstrated when compared with historic controls.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)