Glioblastoma multiforme (GBM) is the most malignant primary brain tumor. Conventional therapies are considered palliative and long-term progression-free survival remains low for most GBM patients even after surgical excision, concomitant radiotherapy and/or chemotherapy with nitrosoureas or Temozolomide. We report the case of a 47-year-oldman who presented worsening headache over a month, accompanied by episodes of morning vomiting and hyposthenia of the left hemisoma. Cerebral tomographic scan revealed an expansive process on the right frontal site. Following surgical resection, the patient was diagnosed with diffusely infiltrating GBM. After surgery, the patient underwent radiotherapy and chemotherapy with Temozolomide for 6 months. Eleven months later, the patient underwent a second-look surgery with excision of a new right superior frontal nodule. This time the patient refused both radio and chemotherapy and underwent follow-up only. After 12 months he underwent a new craniotomy for the excision of a third GBM relapse. Following resection, the patient agreed to be treated for 6 months with fotemustine (FTM) 100 mg/m2 intravenously every 4 weeks as chemotherapy. After 3 months of treatment the patient underwent a full physical examination and diagnostic monitoring of the tumor using Magnetic Resonance Imaging (MRI) of the brain and whole body Computerised Tomography (CT). During FTM treatment, the most frequent, but reversible toxic effect was hematological grade 2 anemia and thrombocytopenia but no other grade >2 toxicity was recorded, so there was no reduction or delay in treatment. Presently, after 8 years of follow-up, the patient is in excellent health and has no evidence of intracranial disease recurrence. In light of this case, post-surgical FTM treatment seems to represent an interesting well-tolerated treatment possibility in patients with recurrent malignant GBM of the brain, given that there are very few reports of such a remission in the literature.
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C. Cerullo, C. Fonte, A. Muto, A. Vannini, M. Rediti, S. Rangan, L. Bordi and B. Neri, "Complete Remission and Long Term Survival in Recurrent Malignant Glioblastoma Treated with Fotemustine Monotherapy: A Case Report," Journal of Cancer Therapy, Vol. 4 No. 2, 2013, pp. 584-587. doi: 10.4236/jct.2013.42075.
 T. A. Dolecek, J. M. Propp, N. E. Stroup and C. Kruchko, “CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2005-2009,” Neuro-Oncology, Vol. 14, No. 5, 2012, pp. v1-v49. doi:10.1093/neuonc/nos218
 R. Stupp, M. E. Hegi and M. J. Van den Bent, et al., “Changing Paradigms; an Update on the Multidisciplinary Management of Malignant Glioma,” Oncologist, Vol. 11, No. 2, 2006, pp. 165-180.
 R. Stupp and F. Roila, “ESMO Giudelines Working Group. Malignant Glioma: ESMO Clinical Recommendations for Diagnosis, Treatment, and Follow-Up,” Annals of Oncology, Vol. 20 Suppl 4, 2009, pp. 126-128.
 H. A. Fine, K. B. Dear, J. S. Loeffler, et al., “Meta-Analysis of Radiation Therapy with and without Adjuvant Chemotherapy for Malignant Gliomas in Adults,” Cancer, Vol. 71, No. 8, 1993, pp. 2585-2597.
 L. A. Stewart, “Chemotherapy in Adult High-Grade Glioma: A Systematic Review and Meta-Analysis of Individual Patient Data from 12 Randomized Trials,” Lancet, Vol. 359, No. 9311, 2002, pp. 1011-1018.
 P. Y. Wen and S. Kesari, “Malignant Gliomas in Adults,” The New England Journal of Medicine, Vol. 359, No. 5, 2008, pp. 429-507. doi:10.1056/NEJMra0708126
 A. Fabi, G. Metro, M. Russillo, et al., “Treatment of Recurrent Malignat Gliomas with Fotemustine Monotherapy: Impact of Dose and Correlation with MGMT Promoter Methylation,” BMC Cancer, Vol. 9, 2009, pp. 101-105.
 M. G. Fabrini, G. Silvano, I. Lolli, et al., “A Multi-Istitutional Phase II Study on Second-Line Fotemustine Chemotherapy in Recurrent Glioblastoma,” Journal of NeuroOncology, Vol. 92, No. 1, 2009, pp. 79-86.
 R. Addeo, M. S. De Santi, S. Del Prete, et al., “Fotemustine and Recurrent Glioblastoma: Possible New Opportunities for an Old Drug,” Cancer Chemotherapy and Pharmacology, Vol. 64, No. 5, 2009, pp. 863-866.
 A. Meulemans, B. Giroux, P. Hannoun, et al., “Comparative Diffusion Study of Two Nitrosoureas: Carmustine and Fotemustine in Normal Rat Brain, Human and Rat Brain Biopsies,” Chemotherapy, Vol. 37, No. 2, 1991, pp. 86-92. doi:10.1159/000238838
 M. Salcman, “Glioblastoma Multiforme and Anaplastic Astrocytoma,” In: A. H. Kaye and Er. Laws Jr., Eds., Brain Tumors: An Encyclopedic Approach, Churchill Livingstone, London, pp. 494-523.
 J. N. Scott, N. B. Rewcastle, P. M. Brasher, et al., “Which Glioblastoma Multiforme Patients Will Become a LongTerm Survivor? A Population-Based Study,” Annals of Neurology, Vol. 46, No. 2, 1999, pp. 183-188.
 R. E. Mc Lendon and E. C. Halperin, “Is the Long-Term Survival of Patients with Glioblastoma Multiforme Overstated?” Cancer, Vol. 98, No. 8, 2003, pp. 1745-1753.
 R. Stupp, W. P. Mason, M. J. Van den Bent, M. Weller, et al., “Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma,” The New England Journal of Medicine, Vol. 352, No. 10, 2005, pp. 978-996.
 M. Mousseau, P. Swiercz, M. Rougny, et al., “Fotemustine in Recurrent Supratentorial Malignant Gliomas,” Drugs of Today, Vol. 32, Suppl. E, 1996, pp. 43-50.
 S. Scoccianti, B. Detti, A. Sardaro, et al., “Second-Line Chemotherapy with Fotemustine in Temozolomide-Pretreated Patients with relapsing Glioblastoma: A Single Institution Experience,” Anti-Cancer Drugs, Vol. 19, No. 6, 2008, pp. 613-620.
 M. Frenay, B. Giroux, S. Khoury, et al., “Phase II Study of Fotemustine in Recurrent Supratentorial Malignant Gliomas,” European Journal of Cancer, Vol. 27, No. 7, 1991, pp. 852-856. doi:10.1016/0277- 5379(91)90133-X
 P. Pinzani, C. Mazzini, B. Neri, et al., “Tyrosinase mRNA Levels in Blood Uveal Melanoma Patients: Correlation between the Number of Circulating Tumor Cells and Tumor Progression,” Melanoma Research, Vol. 20, No. 4, 2010, pp. 303-310. doi:10.1097/CMR.0b013e32833906e3