Date Published: 27 June 2007
Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma
NICE issues guidance on the use of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma
NICE has issued guidance today on the use of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma, a type of cancerous brain tumour.
Brain tumours account for fewer than 2% of all primary cancers. Approximately 1860 new cases of malignant glioma are diagnosed in England and Wales each year. Symptoms vary but can include seizures, visual disturbance, speech and language problems and changes in the ability to carry out normal daily activities, which can be assessed using a performance scale, such as the WHO performance status classification.
Approximately 30% of adults with high-grade gliomas survive for at least 1 year, and 13% survive for 5 years. Diagnosis of high-grade glioma is provisionally made through a computed tomography (CT) scan or MRI. The diagnosis is then confirmed and the tumour classified histologically, either at the time of surgical resection or by a single-event biopsy if surgery is not possible. In the UK, treatment usually consists of surgical resection where possible, followed by radiotherapy. Surgery may achieve either complete resection or partial resection of the tumour. Radiotherapy has been demonstrated to prolong survival and is usually recommended after surgery.
NICE recommends the following:
- Temozolomide, within its licensed indications, is recommended as an option for the treatment of newly diagnosed glioblastoma multiforme (GBM) in patients with a World Health Organization (WHO) performance status of 0 or 1.
- Carmustine implants, within their licensed indications, are recommended as an option for the treatment of newly diagnosed high-grade glioma only for patients in whom 90% or more of the tumour has been surgically removed.
- Carmustine implants are not recommended for the treatment of newly diagnosed high-grade glioma for patients in whom less than 90% of the tumour has been surgically removed.
Andrea Sutcliffe, Deputy Chief Executive at NICE and Executive Lead for this appraisal, said:
“We have recommended temozolomide and carmustine implants for the patient groups who will benefit the most. This is a good use of NHS resources and it will ensure that patients who suffer from this rarer form of cancer are entitled to the same standard of care, regardless of where they live.?
