Clinical Study The Combination of Carmustine Wafers and Fotemustine in Recurrent Glioblastoma Patients: A Monoinstitutional Experience Giuseppe Lombardi, 1 Alessandro Della Puppa, 2 Fable Zustovich, 1 Ardi Pambuku, 1 Patrizia Farina, 1 Pasquale Fiduccia, 3 Anna Roma, 1 and Vittorina Zagonel 1 1 Medical Oncology 1 Unit, Venetian Oncology Institute-IRCCS, Via Gattamelata 64, 35128 Padua, Italy 2 Neurosurgery Department, Azienda Ospedaliera di Padova, 35128 Padua, Italy 3 Clinical Trials and Biostatistics Unit, Venetian Oncology Institute-IRCCS, 35128 Padua, Italy Correspondence should be addressed to Giuseppe Lombardi; giuseppe.lombardi@ioveneto.it Received 12 March 2014; Accepted 25 March 2014; Published 9 April 2014 Academic Editor: Stefano Anna Luisa Di Copyright © 2014 Giuseppe Lombardi et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. To date, there is no standard treatment for recurrent glioblastoma. We analyzed the feasibility of second surgery plus carmustine wafers followed by intravenous fotemustine. Methods. Retrospectively, we analyzed patients with recurrent glioblastoma treated with this multimodal strategy. Results. Twenty-four patients were analyzed. he median age was 53.6; all patients had KPS between 90 and 100; 19 patients (79%) performed a gross total resection > 98% and 5 (21%) a gross total resection > 90%. he median progression-free survival from second surgery was 6 months (95% CI 3.9–8.05) and the median OS was 14 months (95% CI 11.1–16.8 months). Toxicity was predominantly haematological: 5 patients (21%) experienced grade 3-4 thrombocytopenia and 3 patients (12%) grade 3-4 leukopenia. Conclusion. his multimodal strategy may be feasible in patients with recurrent glioblastoma, in particular, for patients in good clinical conditions. 1. Introduction Malignant gliomas account for approximately 50% of all malignant primary brain tumors in adults and glioblastoma is the most common glial tumor. And so glioblastomas are relatively rare tumors and although the prognosis has improved in the last years, the survival is still poor. Standard therapy for newly diagnosed glioblastoma includes surgical resection when feasible, radiotherapy, and temozolomide according to Stupp regimen [1]. However, despite optimal treatment, median survival ranges from 12 to 15 months for glioblastoma [1]. Regarding second-line treatment in patients with recurrent glioblastoma there is no standard therapy. In the last years, there was interest in the role of bevacizumab, alone or in combination with cytotoxic drugs, but the results were conlicting [2–5]. Moreover, various antineoplastic agents, such as procarbazine, carmustine, lomustine, vincristine, rechallenge with temozolomide, and some combinations of those, were used. Numerous retrospective and prospective phase II studies showed an important activity of fotemustine in recurrent glioblastoma [6, 7] with a range of median overall survival from start of fotemustine treatment from 6 months to 11 months [7, 8]. Fotemustine (diethyl 1-{1-[3-(2-chloroethyl)-3-nitrosoureido] ethyl} phosphonate) is an alkylating [9] cytotoxic agent, belonging to the group of nitrosourea. It is characterized by elevated lipophilic properties and a low molecular weight that contribute to facilitation of its passage through the blood-brain barrier [10]. Moreover, fotemustine shows an important difusion in neuronal cells and glia. he antitumor activity of fotemustine is related to its ability to alkylate DNA. Ater intravenous infusion, the plasma concentration reached the steady state in 45 minutes and the plasma concentration varied between 1 and 14 ug/mL disappearing in the blood within three hours [9]. Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 678191, 4 pages http://dx.doi.org/10.1155/2014/678191