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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Failure of alkylating chemotherapy in the treatment of recurrent GBM: the impact of Bevacizumab and Irinotecan as third line therapy

Meeting Abstract

  • Juliane Schroeteler - Klinik für Neurochirurgie, Heinrich-Heine Universität Düsseldorf, Deutschland
  • Marion Rapp - Klinik für Neurochirurgie, Heinrich-Heine Universität Düsseldorf, Deutschland
  • Marta Wallocha - Klinik für Neurochirurgie, Heinrich-Heine Universität Düsseldorf, Deutschland
  • Phillip Grosser - Klinik für Neurochirurgie, Heinrich-Heine Universität Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Klinik für Neurochirurgie, Heinrich-Heine Universität Düsseldorf, Deutschland
  • Michael Sabel - Klinik für Neurochirurgie, Heinrich-Heine Universität Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1537

DOI: 10.3205/10dgnc014, URN: urn:nbn:de:0183-10dgnc0148

Veröffentlicht: 16. September 2010

© 2010 Schroeteler et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Though treatment of primarily diagnosed Glioblastoma multiforme (GBM) has been much improved by the introduction of standardized alkylating chemotherapy, new adjuvant treatment concepts for recurrent GBM after failure of alkylating therapy are needed. Due to their mechanism of action much different from alkylating chemotherapy, the combination of Bevacizumab and Irinotecan (B/I) is a promising new treatment option for recurrent GBM. We therefore evaluated the impact of B/I as a treatment option for GBM patients suffering from second recurrence despite intensified alkylating chemotherapy.

Methods: In a single centre, retrospective case study we performed a data base search for patients with primary GBM, treated with B/I after failure of second line therapy, including implantation of Gliadel® Wafer and intensified chemotherapy with temozolamide (150mg/ sqm body surface, 1 week on /1 week off). B/I treatment consisted of 125 mg/sqm body surface Irinotecan and 10 mg Bevacizumab per KG weight (one cycle corresponding to 3 treatments every two weeks, days 1,15,29). Endpoints were PFS after second recurrence (PFS2, evaluated by McDonald criteria) and survival after initiation of B/I (S-B/I, both calculated in days after initiation of B/I until progression or death), clinical and hematological side effects (WHO criteria), Quality of Life (QoL, EORTC QLQ-C30 with EORTC QLQ-BN20) and OAS. The MGMT-promoter status (MGMT [+] vs. MGMT [-]) was determined by methylation specific PCR.

Results: 9 patients met the inclusion criteria (median age at recurrence 61,5 years). Median number of cycles was 2. Median PFS2 was 14 weeks (CI 95% [11,078–16,922]); S-B/I was 7 months (CI not feasible due to 44% censored patients). One patient suffered from deep vein thrombosis, 2 patients had a grade 2 toxicity, Evaluation of QoL demonstrated a trend of increased global health, decreased future uncertainty and a significant increase of functional scales (p=0.03). Median OAS is at present 2 years (CI 95% [1,175–2,825]). 6/9 patients were MGMT [-], in 3/9 MGMT-Status was not determined.

Conclusions: The small number of patients does not permit final conclusions. However, despite the high rate of MGMT [-] patients the median OAS is impressive. Though aggressively pretreated, patients tolerated the treatment with B/I well, with negligible side effects and even a tendency towards improved QoL. This observation study supports the use of B/I in patients suffering from recurrent GBM.