A case report of successful combined intra-arterial immunotherapy and cytokine genetic therapy treatment in a patient with recurrent glioblastoma.

BACKGROUND: Glioblastoma (GBM) is the most common primary malignant brain tumor with very poor prognosis due to frequent recurrence and short overall survival (OS) time, which according to different sources, is not longer than 17 months after the diagnosis. Infiltrative growth pattern often leads to tumor propagation into functionally significant brain areas while surgery is cytoreductive and does not necessarily alter the prognosis. Many patients are in the working age, thus finding conservative approaches to the treatment of this type of neoplasms is of utmost importance. The aim of the work is to demonstrate the effectiveness of treatment of GBM using cytokine genetic therapy (CGT) and present an algorithm for patient management.

CASE DESCRIPTION: This paper describes the first case of successful intra-arterial (IA) bevacizumab therapy with following CGT of a 46-year-old patient with recurrent GBM after a combined treatment. Sixteen courses of 15 mg/kg IA bevacizumab with hyperosmolar opening of blood-brain barrier (BBB) resulted in stabilization of the neoplastic process. After that, 9 courses of CGT with recombinant interferon gamma (IFN-γ) and tumor necrosis factor (TNF)-thymosin α1 were performed. Both magnetic resonance imaging (MRI) with contrast and positron emission tomography (PET) confirmed a complete response to the combined treatment. OS time is currently more than 25 months from the diagnosis. The observation continues.

CONCLUSIONS: This case study expands the range of treatment options for GBM, especially in the context of intolerance and high toxicity of cytostatic drugs, and may lead to improved recurrence-free survival (RFS).