Brain Cancer

Regimen Options

Last Updated: 06/02/2024 See Details

NOTE: FOR BEVACIZUMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
LOW-GRADE GLIOMAS (E.G. LOW-GRADE ASTROCYTOMA, OTHER LOW-GRADE GLIOMAS)
Adjuvant (with or without radiation)	PCV (procarbazine, lomustine, and vincristine)	Low	High	NCCN Guidelines® for Central Nervous System Cancers V.1.2016. Buckner JC, et al. J Clin Oncol. 2003;21(2):251-5. Medical Research Council Brain Tumour Working Party. J Clin Oncol. 2001;19(2):509-18.
Recurrent	carmustine	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016. Brandes AA, et al. Neurology. 2004;63(7):1281-4. Reithmeier T, et al. BMC Cancer. 2010;10:30. Gornet MK, et al. J Neurooncol. 1999;45(1):61-7.
	temozolomide	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016.
	lomustine	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care.
HIGH-GRADE GLIOMAS [(E.G. ANAPLASTIC ASTROCYTOMA, OTHER HIGH-GRADE GLIOMAS) & GLIOBLASTOMA MULTIFORME (GBM)]
Adjuvant (with or without radiation)	temozolomide	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016. Stupp R, et al. N Engl J Med. 2005;352(10):987-96. Nicholson HS, et al. Cancer. 2007;110(7):1542-50.
	PCV (procarbazine, lomustine, and vincristine)	Low	High	NCCN Guidelines® for Central Nervous System Cancers V.1.2016. Buckner JC, et al. J Clin Oncol. 2003;21(2):251-5. Medical Research Council Brain Tumour Working Party. J Clin Oncol. 2001;19(2):509-18.
Recurrent	bevacizumab	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers. V.1.2017. Chamberlain MC, et al. Cancer. 2009;115(8):1734-43. Chamberlain MC, et al. J Neurooncol. 2009;91(3):359-67.
	bevacizumab and temozolomide	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016. Verhoeff et al. Ann Oncol. 2010 Aug;21(8):1723-7.
	bevacizumab and irinotecan	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers. V.1.2017. Vredenburgh, et al. Clinc Cancer Res. 2007;13(4):1253-9.
	carmustine	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016. Brandes AA, et al. Neurology. 2004;63(7):1281-4. Reithmeier T, et al. BMC Cancer. 2010;10:30. Gornet MK, et al. J Neurooncol. 1999;45(1):61-7.
	temozolomide	Low	Moderate	NCCN Guidelines® for Central Nervous System Cancers V.1.2016.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care.

LOW-GRADE GLIOMAS (E.G. LOW-GRADE ASTROCYTOMA, OTHER LOW-GRADE GLIOMAS)

Adjuvant (with or without radiation)

Evolent Pathways

PCV (procarbazine, lomustine, and vincristine)

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Recurrent

Evolent Pathways

carmustine

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

temozolomide

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

lomustine

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

HIGH-GRADE GLIOMAS [(E.G. ANAPLASTIC ASTROCYTOMA, OTHER HIGH-GRADE GLIOMAS) & GLIOBLASTOMA MULTIFORME (GBM)]

Adjuvant (with or without radiation)

Evolent Pathways

temozolomide

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

PCV (procarbazine, lomustine, and vincristine)

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Recurrent

Evolent Pathways

bevacizumab

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

bevacizumab and temozolomide

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

bevacizumab and irinotecan

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

carmustine

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

temozolomide

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

Pathways and Low-Value Regimens

Brain Cancer