Impact of therapy on quality of life, neurocognitive function and their correlates in glioblastoma multiforme: a review

Roger Henriksson, Thomas Asklund, Hans Skovgaard Poulsen, Roger Henriksson, Thomas Asklund, Hans Skovgaard Poulsen

Abstract

The maintenance of quality of life (QoL) in patients with high-grade glioma is an important endpoint during treatment, particularly in those with glioblastoma multiforme (GBM) given its dismal prognosis despite limited advances in standard therapy. It has proven difficult to identify new therapies that extend survival in patients with recurrent GBM, so one of the primary aims of new therapies is to reduce morbidity, restore or preserve neurologic functions, and the capacity to perform daily activities. Apart from temozolomide, cytotoxic chemotherapeutic agents do not appear to significantly impact response or survival, but produce toxicity that is likely to negatively impact QoL. New biological agents, such as bevacizumab, can induce a clinically meaningful proportion of durable responses among patients with recurrent GBM with an acceptable safety profile. Emerging evidence suggests that bevacizumab produces an improvement or preservation of neurocognitive function in GBM patients, suggestive of QoL improvement, in most poor-prognosis patients who would otherwise be expected to show a sudden and rapid deterioration in QoL.

Figures

Fig. 1
Fig. 1
Change in median corticosteroid use following treatment with bevacizumab with or without irinotecan in patients with recurrent glioblastoma multiforme (adapted with permission from Friedman et al. [61])

References

    1. Louis DN, Ohgaki H, Wiestler OD, Cavanee WK. WHO classication of tumours of the central nervous system. Lyon: IARC; 2007.
    1. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97–109. doi: 10.1007/s00401-007-0243-4.
    1. Garside R, Pitt M, Anderson R et al (2007) The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation. Health Technol Assess 11:iii–iv, ix–221
    1. Gurney JG, Kadan-Lottick N. Brain and other central nervous system tumors: rates, trends, and epidemiology. Curr Opin Oncol. 2001;13:160–166. doi: 10.1097/00001622-200105000-00005.
    1. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–996. doi: 10.1056/NEJMoa043330.
    1. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10:459–466. doi: 10.1016/S1470-2045(09)70025-7.
    1. Wong ET, Hess KR, Gleason MJ, et al. Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials. J Clin Oncol. 1999;17:2572–2578.
    1. Ballman KV, Buckner JC, Brown PD, et al. The relationship between six-month progression-free survival and 12-month overall survival end points for phase II trials in patients with glioblastoma multiforme. Neuro Oncol. 2007;9:29–38. doi: 10.1215/15228517-2006-025.
    1. Fine HA, Puduvalli VK, Chamberlain MC et al (2008) Enzastaurin (ENZ) versus lomustine (CCNU) in the treatment of recurrent, intracranial glioblastoma multiforme (GBM): a phase III study. J Clin Oncol 26(suppl; abstr 2005)
    1. Lamborn KR, Yung WK, Chang SM, et al. Progression-free survival: an important end point in evaluating therapy for recurrent high-grade gliomas. Neuro Oncol. 2008;10:162–170. doi: 10.1215/15228517-2007-062.
    1. Macdonald DR, Kiebert G, Prados M, Yung A, Olson J. Benefit of temozolomide compared to procarbazine in treatment of glioblastoma multiforme at first relapse: effect on neurological functioning, performance status, and health related quality of life. Cancer Invest. 2005;23:138–144.
    1. Meyers C, Boake C. Neurobehavioral disorders experienced by brain tumor patients: rehabilitation strategies. Cancer Bull. 1993;45:362–364.
    1. Meyers CA. Neuropyschologic deficits in brain-tumour patients: effects of location, chronicity, and treatment. Cancer Bull. 1986;38:20–32.
    1. Meyers CA, Scheibel RS. Early detection and diagnosis of neurobehavioral disorders associated with cancer and its treatment. Oncology (Williston Park) 1990;4:115–122.
    1. Taphoorn MJ, Klein M. Cognitive deficits in adult patients with brain tumours. Lancet Neurol. 2004;3:159–168. doi: 10.1016/S1474-4422(04)00680-5.
    1. Bosma I, Vos MJ, Heimans JJ, et al. The course of neurocognitive functioning in high-grade glioma patients. Neuro Oncol. 2007;9:53–62. doi: 10.1215/15228517-2006-012.
    1. Cheng JX, Zhang X, Liu BL. Health-related quality of life in patients with high-grade glioma. Neuro Oncol. 2009;11:41–50. doi: 10.1215/15228517-2008-050.
    1. Giovagnoli AR, Silvani A, Colombo E, Boiardi A. Facets and determinants of quality of life in patients with recurrent high grade glioma. J Neurol Neurosurg Psychiatry. 2005;76:562–568. doi: 10.1136/jnnp.2004.036186.
    1. Khuntia D, Brown P, Li J, Mehta MP. Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol. 2006;24:1295–1304. doi: 10.1200/JCO.2005.04.6185.
    1. Li J, Bentzen SM, Li J, et al. Relationship between neurocognitive function and quality of life after whole-brain radiotherapy in patients with brain metastasis. Int J Radiat Oncol Biol Phys. 2008;71:64–70. doi: 10.1016/j.ijrobp.2007.09.059.
    1. Heimans JJ, Martin J, Taphoorn B. Impact of brain tumour treatment on quality of life. J Neurol. 2002;249:955–960. doi: 10.1007/s00415-002-0839-5.
    1. Fujii DE, Wylie AM. Neurocognition and community outcome in schizophrenia: long-term predictive validity. Schizophr Res. 2003;59:219–223. doi: 10.1016/S0920-9964(01)00328-0.
    1. Stong C (2003) Can neurocognition predict future quality of life in patients with mental illness? . Accessed 5 May 2009
    1. Fujii DE, Wylie AM, Nathan JH. Neurocognition and long-term prediction of quality of life in outpatients with severe and persistent mental illness. Schizophr Res. 2004;69:67–73. doi: 10.1016/S0920-9964(03)00122-1.
    1. Roa W, Brasher Pm, Bauman G, et al. Abbreviation course of radiation therap in lder patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol. 2004;22:1582–1588. doi: 10.1200/JCO.2004.06.082.
    1. Walker M, Brown J, Brown K, et al. Practical problems with the collection and interpretation of serial quality of life assessments in patients with malignant glioma. J Neurooncol. 2003;63:179–186. doi: 10.1023/A:1023900802254.
    1. Correa DD. Neurocognitive function in brain tumors. Curr Neurol Neurosci Rep. 2010;10:232–239. doi: 10.1007/s11910-010-0108-4.
    1. Klein M, Heimans JJ, Aaronson NK, et al. Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study. Lancet. 2002;360:1361–1388. doi: 10.1016/S0140-6736(02)11398-5.
    1. Klein M, Engelberts NH, van der Ploeg HM, et al. Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol. 2003;54:514–520. doi: 10.1002/ana.10712.
    1. Taphoorn MJ. Neurocognitive sequelae in the treatment of low-grade gliomas. Semin Oncol. 2003;30(6 Suppl 19):45–48. doi: 10.1053/j.seminoncol.2003.11.023.
    1. Klein M, Taphoorn MJ, Heimans JJ, et al. Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol. 2001;19:4037–4047.
    1. Lupien SJ, Gillin CJ, Hauger RL. Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behav Neurosci. 1999;113:420–430. doi: 10.1037/0735-7044.113.3.420.
    1. Young AH, Sahakian BJ, Robbins TW, Cowen PJ. The effects of chronic administration of hydrocortisone on cognitive function in normal male volunteers. Psychopharmacology (Berl) 1999;145:260–266. doi: 10.1007/s002130051057.
    1. de Vries MA, van Litsenburg RR, Huisman J, et al. Effect of dexamethasone on quality of life in children with acute lymphoblastic leukaemia: a prospective observational study. Health Qual Life Outcomes. 2008;6:103. doi: 10.1186/1477-7525-6-103.
    1. Hempen C, Weiss E, Hess CF. Dexamethasone treatment in patients with brain metastases and primary brain tumors: do the benefits outweigh the side-effects? Support Care Cancer. 2002;10:322–328. doi: 10.1007/s00520-001-0333-0.
    1. Sturdza A, Millar BA, Bana N, et al. The use and toxicity of steroids in the management of patients with brain metastases. Support Care Cancer. 2008;16:1041–1048. doi: 10.1007/s00520-007-0395-8.
    1. Taphoorn MJ, Stupp R, Coens C, et al. Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol. 2005;6:937–944. doi: 10.1016/S1470-2045(05)70432-0.
    1. Osoba D, Brada M, Yung WK, Prados M. Health-related quality of life in patients treated with temozolomide versus procarbazine for recurrent glioblastoma multiforme. J Clin Oncol. 2000;18:1481–1491.
    1. Yung WK, Albright RE, Olson J, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer. 2000;83:588–593. doi: 10.1054/bjoc.2000.1316.
    1. Brada M, Hoang-Xuan K, Rampling R, et al. Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol. 2001;12:259–266. doi: 10.1023/A:1008382516636.
    1. Hart MG, Grant R, Garside R et al (2008) Temozolomide for high grade glioma. Cochrane Database Syst Rev 4:CD007415
    1. Taphoorn MJ, van den Bent MJ, Mauer ME, et al. Health-related quality of life in patients treated for anaplastic oligodendroglioma with adjuvant chemotherapy: results of a European Organisation for Research and Treatment of Cancer randomized clinical trial. J Clin Oncol. 2007;25:5723–5730. doi: 10.1200/JCO.2007.12.7514.
    1. Wang M, Cairncross G, Shaw E et al (2009) Cognition and quality of life after chemotherapy plus radiotherapy (RT) vs. RT for pure and mixed anaplastic oligodendrogliomas: radiation therapy oncology group trial 9402. J Clin Oncol 27(suppl; abstr e20519)
    1. Corn BW, Wang M, Fox S, et al. Health related quality of life and cognitive status in patients with glioblastoma multiforme receiving escalating doses of conformal three dimensional radiation on RTOG 98-03. J Neurooncol. 2009;95:247–257. doi: 10.1007/s11060-009-9923-3.
    1. Trojanowski T, Peszyński J, Turowski K, et al. Quality of survival of patients with brain gliomas treated with postoperative CCNU and radiation therapy. J Neurosurg. 1989;70:18–23. doi: 10.3171/jns.1989.70.1.0018.
    1. Hart MG, Grant R, Garside R et al (2008) Chemotherapeutic wafers for high grade glioma. Cochrane Database Syst Rev 3:CD007294
    1. Yang JC, Haworth L, Sherry RM, et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003;349:427–434. doi: 10.1056/NEJMoa021491.
    1. Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–2342. doi: 10.1056/NEJMoa032691.
    1. Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355:2542–2550. doi: 10.1056/NEJMoa061884.
    1. Miller K, Wang M, Gralow J, et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med. 2007;357:2666–2676. doi: 10.1056/NEJMoa072113.
    1. Stark-Vance V. Bevacizumab and CPT-11 in the treatment of relapsed malignant glioma. Neuro Oncol. 2005;7:369.
    1. Raval S, Hwang S, Dorsett L (2007) Bevacizumab and irinotecan in patients (pts) with recurrent glioblastoma multiforme (GBM). J Clin Oncol 25(suppl; abstr 2078)
    1. Vredenburgh JJ, Desjardins A, Herndon JE, 2nd, et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol. 2007;25:4722–4729. doi: 10.1200/JCO.2007.12.2440.
    1. Vredenburgh JJ, Desjardins A, Herndon JE, 2nd, et al. Phase II trial of bevacizumab and irinotecan in recurrent malignant glioma. Clin Cancer Res. 2007;13:1253–1259. doi: 10.1158/1078-0432.CCR-06-2309.
    1. Ali SA, McHayleh WM, Ahmad A, et al. Bevacizumab and irinotecan therapy in glioblastoma multiforme: a series of 13 cases. J Neurosurg. 2008;109:268–272. doi: 10.3171/JNS/2008/109/8/0268.
    1. Bokstein F, Shpigel S, Blumenthal DT. Treatment with bevacizumab and irinotecan for recurrent high-grade glial tumors. Cancer. 2008;112:2267–2273. doi: 10.1002/cncr.23401.
    1. Cloughesy TF, Prados MD, Wen PY et al (2008) A phase II, randomized, non-comparative clinical trial of the effect of bevacizumab (BV) alone or in combination with irinotecan (CPT) on 6-month progression free survival (PFS6) in recurrent, treatment-refractory glioblastoma (GBM). J Clin Oncol 26(suppl; abstr 2010b)
    1. Desjardins A, Reardon DA, Herndon JE, 2nd, et al. Bevacizumab plus irinotecan in recurrent WHO grade 3 malignant gliomas. Clin Cancer Res. 2008;14:7068–7073. doi: 10.1158/1078-0432.CCR-08-0260.
    1. Guiu S, Taillibert S, Chinot O, et al. Bevacizumab/irinotecan. An active treatment for recurrent high grade gliomas: preliminary results of an ANOCEF Multicenter Study. Rev Neurol (Paris) 2008;164:588–594.
    1. Norden AD, Young GS, Satayesh K, et al. Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence. Neurology. 2008;70:779–787. doi: 10.1212/01.wnl.0000304121.57857.38.
    1. Friedman HS, Prados MD, Wen PY, et al. Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol. 2009;27:4733–4740. doi: 10.1200/JCO.2008.19.8721.
    1. Gilbert MR, Wang M, Aldape K et al (2009) RTOG 0625: A phase II study of bevacizumab with irinotecan in recurrent glioblastoma (GBM). J Clin Oncol 27(suppl; abstr 2011)
    1. Nghiemphu PL, Liu W, Lee Y, et al. Bevacizumab and chemotherapy for recurrent glioblastoma: a single-institution experience. Neurology. 2009;72:1217–1222. doi: 10.1212/01.wnl.0000345668.03039.90.
    1. Poulsen HS, Grunnet K, Sorensen M, et al. Bevacizumab plus irinotecan in the treatment patients with progressive recurrent malignant brain tumours. Acta Oncol. 2009;48:52–58. doi: 10.1080/02841860802537924.
    1. Zuniga RM, Torcuator R, Jain R, et al. Efficacy, safety and patterns of response and recurrence in patients with recurrent high-grade gliomas treated with bevacizumab plus irinotecan. J Neurooncol. 2009;91:329–336. doi: 10.1007/s11060-008-9718-y.
    1. Cloughesy T, Vredenburgh JJ, Day B et al (2010) Updated safety and survival of patients with relapsed glioblastoma treated with bevacizumab in the BRAIN study. J Clin Oncol 28(suppl; abstr 2008)
    1. Desjardins A, Vredenburgh JJ, Reardon DA et al (2010) Long-term survival from the initial trial of bevacizumab and irinotecan. J Clin Oncol 28(suppl; abstr 2045)
    1. Reardon D, Desjardins A, Vredenburgh JJ et al (2009) Bevacizumab plus etoposide among recurrent malignant glioma patients: phase II study final results. J Clin Oncol 27(suppl; abstr 2046)
    1. Soffietti R, Rudà R, Trevisan E et al (2009) Phase II study of bevacizumab and nitrosourea in patients with recurrent malignant glioma: A multicenter Italian study. J Clin Oncol 27(suppl; abstr 2012)
    1. Trevisan E, Picco E, Rudà R et al (2009) Salvage therapy with bevacizumab and fotemustine in recurrent high grade glioma. Eur J Can Suppl 7:499(abstr P-8719)
    1. Sathornsumetee S, Desjardins A, Vredenburgh JJ et al (2010) Phase II study of bevacizumab plus erlotinib for patients with recurrent malignant gliomas: final results. J Clin Oncol 28(suppl; abstr 2055)
    1. Gutin PH, Iwamoto FM, Beal K, et al. Safety and efficacy of bevacizumab with hypofractionated stereotactic irradiation for recurrent malignant gliomas. Int J Radiat Oncol Biol Phys. 2009;13:1200–1206.
    1. Kreisl TN, Kim L, Moore K, et al. Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol. 2009;27:740–745. doi: 10.1200/JCO.2008.16.3055.
    1. Raizer JJ, Grimm S, Rice L et al (2009) A phase II trial of single-agent bevacizumab given every 3 weeks for recurrent malignant gliomas. J Clin Oncol 27(suppl; abstr 2044)
    1. Lai A, Filka E, McGibbon B, et al. Phase II pilot study of bevacizumab in combination with temozolomide and regional radiation therapy for up-front treatment of patients with newly diagnosed glioblastoma multiforme: interim analysis of safety and tolerability. Int J Radiat Oncol Biol Phys. 2008;71:1372–1380. doi: 10.1016/j.ijrobp.2007.11.068.
    1. Gruber ML, Raza S, Gruber D et al (2009) Bevacizumab in combination with radiotherapy plus concomitant and adjuvant temozolomide for newly diagnosed glioblastoma: update progression-free survival, overall survival, and toxicity. J Clin Oncol 27(suppl; abstr 2017)
    1. Nicholas MK, Lucas RV, Arzbaecher J et al (2009) Bevacizumab in combination with temozolomide in the adjuvant treatment of newly diagnosed glioblastoma multiforme: preliminary results of a phase II study. J Clin Oncol 27(suppl; abstr 2016)
    1. Vredenburgh JJ, Desjardins A, Reardon DA et al (2010) Bevacizumab (BEV) in combination with temozolomide (TMZ) and radiation therapy (XRT) followed by BEV, TMZ, and irinotecan for newly diagnosed glioblastoma multiforme (GBM). J Clin Oncol 28(suppl; abstr 2023)
    1. Omuro AM, Beal K, Karimi S et al (2010) Phase II study of bevacizumab (BEV), temozolomide (TMZ), and hypofractionated stereotactic radiotherapy (HFSRT) for newly diagnosed glioblastoma (GBM). J Clin Oncol 28(suppl; abstr 2036)
    1. Vredenburgh JJ, Wefel J, Coughesy T et al (2009) Clinical assessment of corticosteroid use and neurocognitive function in patients with glioblastoma at first or second relapse treated with bevacizumab in the BRAIN study. Eur J Cancer Suppl 7:495(abstr O-8701)
    1. Wefel JS, Cloughesy T, Zazzali J et al (2009) Neurocognitive function in patients with glioblastoma multiforme in first or second relapse treated with bevacizumab in the BRAIN study. J Clin Oncol 27(suppl; abstr 2056)
    1. Green RM, Woyshner EA, Nghiemphu L et al (2010) Use of bevacizumab to faciliate up-front chemoradiation in poor-risk patients with glioblastoma multiforme by improving neurologic function. J Clin Oncol 28(suppl; abstr 2059)
    1. Batchelor TT, Duda DG, di Tomaso E, et al. Phase II study of cediranib, an oral pan-vascular endothelial growth factor receptor tyrosine kinase inhibitor, in patients with recurrent glioblastoma. J Clin Oncol. 2010;28:2817–2823. doi: 10.1200/JCO.2009.26.3988.

Source: PubMed

3
Subscribe