Regorafenib in glioblastoma recurrence: how to deal with conflicting ‘real-life’ experiences?

摘要

To date, treatment options for glioblastoma recurrence are scarce. Based on efficacy data from randomized clinical trials, the nitrosourea compound CCNU (lomustine) is considered standard treatment after temozolomide failure. Treatment with lomustine in recurrent glioblastoma yields median overall survival (mOS) ranging from 8.6–9.8 months and median progression-free survival (mPFS) from 1.5–2.7 months. In a recently published open-label, randomized, phase II trial (REGOMA trial) of patients with first glioblastoma recurrence, regorafenib was found superior to lomustine with mOS of 7.4 months in regorafenib-treated patients as opposed to 5.6 months in lomustine treated patients. The radiographically assessed disease control rate (defined as complete/partial response or stable disease) was 44% in the regorafenib arm and 20% in the lomustine control arm. A yet unanswered question is whether regorafenib is going to replace lomustine as standard treatment should regorafenib superiority be confirmed in a planned randomized phase III trial.