No contemporary schemes for the treatment of glioblastoma multiforme (GBM) are thought to be curative. Nevertheless, recent researches on the gene mutations and molecular interactions lead to the elaboration of more promising and tailored approaches.
No contemporary schemes for the treatment of glioblastoma multiforme (GBM) are thought to be curative. Nevertheless, recent researches on the gene mutations and molecular interactions lead to the elaboration of more promising and tailored approaches. Currently, the internationally approved treatment includes maximal surgical resection, radiotherapy, and chemotherapy with temozolomide administration. Doctors still work on overcoming obstacles like tumor heterogeneity, localization of the tumor in the vital brain regions, and high relapse rates.
Surgical and invasive treatment
Treatment of glioblastoma in Germany always implies a multidisciplinary approach. The first step is maximal safe surgical resection. Several clinical trials have demonstrated a strong correlation between the greater extent of resection and longer overall and progression-free survival.
Comprehensive preoperative diagnosis leads to better functional outcomes and helps to avoid a postoperative neurological deficit. It includes diffusion tensor imaging, functional MRI and mapping techniques. In addition, fluorescence guidance with the application of 5-aminolevulinic acid (5-ALA) allows distinguishing normal brain tissue and the residual tumor right during the surgical intervention. The neuronavigation-guided surgery is used for this purpose as well.
MRI-guided laser ablation is the more sparing option for patients with small glioblastomas. This is a form of stereotactic radiosurgery that destructs the neoplasm with focused radiation instead of the surgical scalpel.
Radiation and systemic treatment
Surgical treatment of brain cancer is always followed by chemoradiation. A patient typically needs to wait for 3-4 weeks before the wound from the craniotomy is completely healed, and starts chemoradiation after this.
Today, German specialists give preference to the internationally recommended Stupp regimen, which combines the external beam radiation therapy with the concomitant administration of temozolomide. In Germany, the standard of radiation care includes intensity-modulated or three-dimensional conformal beam radiotherapy. These irradiation modalities are connected with fewer side effects compared to the conventional whole-brain radiotherapy. The recommended total dose of radiation is 60 Gy, given 5 days per week for 6 weeks.
The effect of chemotherapy with temozolomide or lomustine depends significantly on the MGMT gene methylation status. Being methylated (i.e. not active) MGMT compromises repair of the DNA and suppresses tumor progression or recurrence. Thus, methylation of MGMT is a strong predictor of a better response to temozolomide.
Novel options are underway
During the search of non-conventional approaches to glioblastoma treatment, a neurosurgeon Marc-Eric Halatsch and a psychiatrist Richard Kast have created the idea of adding 9 off-label drugs to the approved therapy scheme. “Off-label” means that these medications are already used in practical medicine but are aimed for non-oncologic disorders.
The scheme is called Coordinated Undermining of Survival Paths by 9 Repurposed Drugs (CUSP9). It was first presented as early as 2013. Currently, the Ulm University Hospital in Germany holds the clinical trial that investigates the 3rd version of this protocol.
CUSP9 protocol includes:
- Aprepitant (NK-1 receptor inhibitor).
- Minocycline (antibiotic of the tetracycline group).
- Ritonavir (protease inhibitor).
- Disulfiram (ALDH inhibitor).
- Celecoxib (COX inhibitor).
- Captopril (ACE inhibitor).
- Itraconazole (an antifungal drug).
- Sertraline (SSRI).
- Auranofin (gold complex).
Comfortable visiting the German hospital with Booking Health
International patients receive treatment of glioblastoma in Germany with reliable assistance of Booking Health. The Booking Health company is the certified provider of medical tourism that arranges treatment abroad for patients from over 70 countries. Range of company’s services includes but is not limited to:
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- Approving the therapy dates and booking the appointment.
- Providing independent monitoring of the program implementation.
- Buying and forwarding of medications for the subsequent pharmacotherapy.
- Providing reasonable cost of medical services, saving up to 50% of the price for the foreigners.
- Control of the final calculation.
- Assistance in performing the follow-up examinations.
- Assistance in booking hotels and tickets, transfer organization.
- Services of the interpreter, translation of the medical reports.