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Glioblastoma — SCE Medical Oncology MCQ

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HardCNS TumoursGlioblastomaSCE Medical Oncology

A fit patient has first recurrence of glioblastoma eight months after surgery, radiotherapy and temozolomide. Multifocal contralateral disease is not resectable and the MDT considers focal re-irradiation unsuitable. Which systemic option is consistent with NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Offer lomustine alongside discussion of clinical-trial and supportive-care options

Explanation lettering: C = shown as B · D = shown as C · E = shown as D · B = shown as E

E is correct. NICE includes lomustine among treatment options at recurrence after considering performance status, prior treatment, tumour characteristics and patient preference. Clinical trials and symptom-directed care should be discussed because benefit is limited. Carmustine wafers require an operative cavity and are not a solution for unresected multifocal disease; high-dose methotrexate is not standard glioblastoma salvage; temozolomide rechallenge is selective rather than automatic; and NICE specifically advises against bevacizumab for recurrent high-grade glioma. The original keyed option was internally unsafe because it listed bevacizumab as though it were endorsed.

Reference: NICE NG99 brain tumour recommendations: https://www.nice.org.uk/guidance/ng99/chapter/recommendations