From relapse to survival: real-world clinical impact of a multimodal approach in first-time recurrent glioblastoma : FROST: multimodal treatment for GBM recurrence.

BACKGROUND

Glioblastoma (GBM) is the most common malignant brain tumor in adults. The current treatment is surgery followed by chemoradiotherapy (CRT) and adjuvant temozolomide (TMZ). Three out of four patients experience recurrence within the year following diagnosis. The management of first GBM recurrence remains challenging with no standardized guidelines. This study aimed to evaluate multimodal strategies combining systemic therapy, radiotherapy, surgery as a potential promising approach to enhance patient outcomes.

METHODS

The FROST study is a real-life multicenter study. All patients with primary GBM treated for recurrence after prior CRT were included. The Kaplan-Meier method, Cox regression model, and propensity score were employed.

RESULTS

Two hundred seventy-one patients were included. One hundred ninety (70%) patients benefited from systemic treatment. Fifty-six patients (21%) received a multimodal approach, and 25 (9%) either radiotherapy (n = 14) or surgery (n = 11) alone. The median OS was 9.9 months (8.2-11.2) from first recurrence. The median OS for systemic treatment was 7.9 months (7.1-10.4) and 12.7 months (10.8-19.6) for the local/multimodal approach (p = 1e- 03). Using local/multimodal treatment as reference, the Cox-stratified hazard ratio (HR) for systemic treatment was 2.64 (1.42-4.89). The multimodal approach was more effective than the local strategy alone, with an OS of 16.2 months (11.2-22.9) versus 9.3 months (8.2-18.7) (p = 0.03), and a multivariate HR of 1.88 (1.05-3.4) for local strategy alone.

CONCLUSION

Integrating systemic therapy, radiotherapy and surgery within a multimodal framework at first GBM recurrence seems to offer meaningful clinical benefit.

CLINICAL TRIAL NUMBER: Not applicable.