STATEMENT OF NEED/TARGET AUDIENCE

The incidence of malignant brain tumors has been increasing during the past 25 years, especially among the elderly, in whom growth has reached 1.2 percent per year. Astrocytic tumors account for more than 50 percent of primary brain cancers (comprising approximately 10,000 of the estimated 18,820 new CNS neoplasms in the US in 2006) and include the most frequently diagnosed gliomas in North America: the WHO Grade III anaplastic astrocytoma (AA) and the WHO Grade IV glioblastoma multiforme (GBM). Brain tumor grade is a robust prognostic factor. Despite current treatment, the overall survival rates for patients with WHO Grade III AA is two to three years, and those with Grade IV GBM generally succumb to their disease within a year from diagnosis. Thus, clinician education regarding standard and evolving optimal therapeutic management of these prevalent neoplasms is of the utmost importance to improve patient outcomes. Current management of high-grade malignant gliomas involves an interdisciplinary approach, integrating the knowledge and expertise of neurosurgeons, radiation oncologists, neuroradiologists and medical oncologists. Whereas the historical mainstay of initial therapy for both AA and GBM has included surgical resection, when feasible, and postoperative radiation therapy, recent advances in clinician understanding of glioma pathophysiology, mechanisms of resistance to standard chemotherapeutics and improvements in medication delivery across the blood-brain barrier have offered an opportunity to enhance available treatment options.

LEARNING OBJECTIVES

• Critically evaluate the implications of emerging clinical trial data focused on local and systemic treatment of primary brain tumors, and incorporate these data into management strategies in the front-line, recurrent and refractory-disease settings.
• Counsel appropriately selected patients with high-grade glioma about the availability of ongoing clinical trials.
• Describe the epidemiologic, demographic and prognostic trends for malignant gliomas, and effectively communicate this information to patients and caregivers.
• Describe the pathogenesis of high-grade gliomas, including the unique biologic and anatomic challenges relevant to the successful access, selection, activity and resistance of systemic therapeutics.
• Discuss the historic and evolving role of adjuvant chemoradiation therapy, and demonstrate the evidence-based application of this information in the management of Grade III and Grade IV gliomas.
• Develop an evidence-based treatment algorithm for the sequential use of local and systemic interventions in the management of recurrent or refractory high-grade gliomas, incorporating individualized patient risk-benefit assessments.
• Provide a summary of the scientific rationale and recent clinical trial results that support the future investigation of angiogenesis and multikinase inhibitors in the medical management of GBM.
• Communicate to patients the incidence and presentation of common treatment-associated adverse effects, and recommend management strategies to address tolerability issues.

PURPOSE OF THIS ISSUE OF MALIGNANT GLIOMA UPDATE

The purpose of Issue 1 of Malignant Glioma Update is to support the learning objectives by offering the perspectives of Drs Vredenburgh, Friedman, Raizer and Abrey on the integration of emerging clinical research data into the management of malignant gliomas.

ACCREDITATION STATEMENT

Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT

Research To Practice designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

HOW TO USE THIS CME ACTIVITY

This CME activity contains both audio and print components. To receive credit, the participant should listen to the CDs, review the Internet content and complete the Post-test and Educational Assessment located at MalignantGliomaUpdate.com/CME. MalignantGliomaUpdate.com contains edited comments, clinical trial schemas, graphics and references that supplement the audio program, as well as links to relevant full-text articles, abstracts, trial information and other web resources.

This program is supported by educational grants from AstraZeneca Pharmaceuticals LP, Genentech BioOncology and MGI Pharma Inc.

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EDITOR
Neil Love, MD

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