Malignant Glioma Patients: Combined Treatment with Radiation and Fotemustine

Abstract

Malignant gliomas account for approximatively 60% of all primary brain tumours in adults. The prognosis for malignant glioma patients has not significantly changed in recent years. Despite debulking surgery, radiotherapy and cytotoxic chemotherapy, median survival duration is 9-12 months and virtually no patients are cured of their illness. Fotemustine is an alkylating agent characterised by the grafting of a phosphonoalanine group onto the nitrosourea radical with consequent high lipophilia and improved diffusion through the cell membrane and the blood-brain barrier. Fotemustine has been registered for use in two indications: disseminated malignant melanoma including cerebral metastases, and primary brain tumours. Fotemustine can be used for recurrent tumours either after radiotherapy, or in a neo-adjuvant schedule or concomitantly to radiotherapy for de novo malignant gliomas. We now go on to describe all the combinations currently in clinical use.