On glioblastoma and the search for a cure: where do we stand?

Abstract

Although brain tumours have been documented and recorded since the nineteenth century, 2016 marked 90 years since Percival Bailey and Harvey Cushing coined the term "glioblastoma multiforme". Since that time, although extensive developments in diagnosis and treatment have been made, relatively little improvement on prognosis has been achieved. The resilience of GBM thus makes treating this tumour one of the biggest challenges currently faced by neuro-oncology. Aggressive and robust development, coupled with difficulties of complete resection, drug delivery and therapeutic resistance to treatment are some of the main issues that this nemesis presents today. Current treatments are far from satisfactory with poor prognosis, and focus on palliative management rather than curative intervention. However, therapeutic research leading to developments in novel treatment stratagems show promise in combating this disease. Here we present a review on GBM, looking at the history and advances which have shaped neurosurgery over the last century that cumulate to the present day management of GBM, while also exploring future perspectives in treatment options that could lead to new treatments on the road to a cure.

Keywords: Cancer stem cells; Drug delivery; Glioblastoma multiforme; Therapeutic resistance.

Fig. 1

Schematic chart showing glioma classification based on the predominant cellular composition of each tumour group by Bailey and Cushing. Adapted from Ref. [30]

Fig. 2

Graphical summary of the last 90 years outlining the major time points from the classification of GBM by Bailey and Cushing to treatments available today, with on outlook of what treatment modalities the future may hold. ICD-O International Classification of Diseases for Oncology, TMZ temozolomide, BCNU carmustine, WHO World Health Organization, TTFs tumour treating fields, BBB blood brain barrier, CED convection enhanced delivery, PCD peptide-carrier mediated delivery, US ultrasound mediated delivery