Systematic review and network meta-analysis of treatments for relapsing or refractory glioblastoma

Glioblastoma is an aggressive primary central nervous system tumor characterized by poor outcomes. The optimal treatment for relapsing glioblastoma after adjuvant chemotherapy is not clear. Systematic review and network meta-analysis of 24 phase 2 and 3 studies, comparing 27 regimens in 3733 patients, found that with lomustine monotherapy as comparator, only regorafenib was significantly superior in terms of overall survival (HR 0.50; 95% CrI 0.33-0.75). Regorafenib was significantly superior to 70% of the other regimens, including NovoTTF-100A, bevacizumab monotherapy, and several bevaciumab-based combinations. In terms of progression-free survival and objective response rate, no treatment was clearly superior to the others. However, most studies in the analysis were underpowered, with varying inclusion criteria. The authors conclude that, based on the currently available information, regorafenib is one of the best available options for relapsing or refractory glioblastoma.