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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Bevacizumab and Irinotecan therapy in recurrent malignant glioma, is it really effective?

Meeting Abstract

  • J. Schroeteler - Department for Neurosurgery, Universität Düsseldorf; Department for Neurosurgery, Universität Münster
  • M. Rapp - Department for Neurosurgery, Universität Düsseldorf
  • G. Stoffels - Department for Nuclear Medicine, Centre of Science Jülich, Universität Düsseldorf
  • H.J. Steiger - Department for Neurosurgery, Universität Düsseldorf
  • W. Stummer - Department for Neurosurgery, Universität Münster
  • M.C. Sabel - Department for Neurosurgery, Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.03.07

DOI: 10.3205/11dgnc120, URN: urn:nbn:de:0183-11dgnc1208

Published: April 28, 2011

© 2011 Schroeteler et al.
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Outline

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Objective: Despite extensive treatment with alkylating chemotherapy, most patients with malignant gliomas suffer from a recurrence within 12 months. We therefore decided to treat extensively pre-treated patients upon recurrence with Bevacizumab (B), an antibody against VEGF, and Irinotecan (I), a topoisomerase I inhibitor. We also performed early MRI and FET-PET studies after treatment with Bevacizumab and Irinotecan to elicit any immediate early effect on the blood brain barrier. Effects on OAS and PFS of this therapy were evaluated.

Methods: 29 patients with recurrent malignant gliomas [20 GBM (WHO°IV), 6 anaplastic astrocytomas (WHO°III) and 3 secondary GBM (WHO°IV)] were included in this retrospective analysis. All patients have been previously treated with radiation and chemotherapy (Stupp) with a median pre-treatment TMZ cycle count of 10. 18 patients received Gliadel Implantation as second line therapy. 12 patients received B/I as second line therapy, 13 patients as third and 4 patients as fourth line therapy. The median observation time was 24 months (11–37). Patients were treated every second week with 10 mg/kg (B) and 125 mg/m2 (I) in a six weeks cycle. The median number of cycles was 2 (1–9). 14 patients were followed by MRI and FET-PET, 15 patients underwent MRI studies only. Two patients underwent FET-PET scans 3 and 5 days after the first therapy.

Results: All 14 patients evaluated with FET-PET showed less tracer uptake on first FET-PET imaging. In two cases there was an extremely early response in terms of reduced enhancement in FET-PET scans, 3 and 5 days after first therapy. MRI obtained at 1 month follow-up showed tumor progression in 7 patients and stable disease in 4 patients. Median PFS was 18 weeks for all patients. 19 patients showed multifocal progression in MRI. For patients with GBM, AA and sec. GBM a PFS of 15 weeks, 18 weeks and 51 weeks was noticed. The complete OAS was 30 months from initial diagnosis until death. The median OAS was 7 months after initiating therapy with B/I.

Conclusions: The immediate early response in FET-PET and MRI may indicate a direct effect on vascular permeability rather than true remission. However, the median PFS of 18 weeks, as well as the OAS of 7 months suggests that treatment with B/I might have some effect in this extensively pre-treated population