Glioblastoma is the most common malignant primary brain tumor. Cures are rare 
and median survival varies from several to 22 months. Standard treatment for 
good performance patients consists of maximal safe surgical resection followed 
by radiotherapy with concurrent temozolomide (TMZ) chemotherapy and six cycles 
of postradiotherapy TMZ. At recurrence, treatment options include repeat surgery 
(with or without Gliadel wafer placement), reirradiation or systemic therapy. 
Most patients with good performance status are treated with cytotoxic 
chemotherapy or targeted biologic therapy following or in lieu of repeat 
surgery. Cytotoxic chemotherapy options include nitrosoureas, rechallenge with 
TMZ, platins, phophoramides and topoisomerase inhibitors, although efficacy is 
limited. Despite the intense effort of developing biologic agents that target 
angiogenesis and growth and proliferative pathways, bevacizumab is the only 
agent that has shown efficacy in clinical trials. It was awarded accelerated 
approval in the USA after demonstrating an impressive radiographic response in 
two open-label, prospective Phase II studies. Two randomized, Phase III trials 
of upfront bevacizumab have completed and may demonstrate survival benefit; 
however, results are pending at this time. Given the limited treatment options 
at tumor recurrence, consideration for enrollment on a clinical trial is 
encouraged.