Improving the standard of care in glioblastoma: novel diagnostic and therapeutic approaches

This thesis focuses on improving the standard of care for patients with glioblastoma, the most common and most aggressive primary brain tumor found in adults. Currently, patients with glioblastoma have a dismal prognosis due to the limited treatment options and their modest efficacy. In this thesis, the current standard of care for patients with newly diagnosed and recurrent glioblastoma was evaluated. We can conclude that the limited benefit from treatment options for patients with glioblastoma provokes the urgent need for novel treatment strategies to improve the quality of life and survival of these patients (chapter 2). Furthermore, MRI is still considered as the most optimal imaging modality for the evaluation of treatment response and effects in glioblastoma. However, the research in this thesis emphasizes the current challenges in the accurate assessment of treatment response and disease progression in these patients (chapter 3). We can, therefore, conclude that additional imaging techniques, including MR imaging features, can provide valuable information on tumor biology, tumor extent and tumor progression. In addition, the research presented in this thesis identified promising novel therapeutic targets (i.e. XIAP, RRM2 and MAPK9) and warrants further investigation (chapter 4). Furthermore, the STELLAR study is exploring an innovative treatment approach with high-dose, intermittent sunitinib in recurrent glioblastoma and is currently enrolling patients (chapter 5). Lastly, based on our systematic review, we concluded that, in its current state, immune checkpoint inhibitors demonstrate limited efficacy in patients with glioblastoma or brain metastases (chapter 6).