An Outcomes Analysis of Carmustine Wafers with Surgery versus Placebo Wafers with Surgery in the Treatment of Glioblastoma Multiforme

Abstract

Objectives: To evaluate the efficacy of carmustine wafers over placebo plus surgery in the treatment of primary glioblastoma multiforme. Methods: Searches of MEDLINE (1966-2007), ASH (American Society of Hematology) abstracts, and ASCO (American Society of Clinical Oncology) abstracts were conducted to obtain clinical outcomes data (meta- analysis, randomized controlled studies) for the carmustine wafers or for the traditional form of therapy, surgical resection of glioblastoma multiforme. Serious adverse events associated with the chemotherapeutic agent were identified and their respective rates of incidence calculated. Three prospective randomized controlled trials were used to provide point estimates and distributions for the Monte Carlo simulation. Parameters used to populate the Markov model were derived from the extant primary literature for patients undergoing surgical resection with either carmustine or placebo for glioblastoma multiforme. The base case was a 50 year old male with primary glioma. Results: Findings indicated that carmustine wafers increased survival over placebo from 54.05 months [95% confidence interval 46.25-61.07] to 69.87 months [95% confidence interval 67.02-71.94]. Serious side effects such as intracranial hemorrhage, seizures, and infections were also taken into account in the decision analytic model. Conclusions: Carmustine wafers significantly increase survival in patients undergoing surgical resection for glioblastoma multiforme. Therefore, carmustine wafers should be used as an adjunct to surgery in these patients.