Article
Progression-free and overall survival in patients with recurrent GBM treated with Bevacizumab versus Bevacizumab/Lomustine
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Authors
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Dieter Henrik Heiland
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
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Waseem Masalha
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
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Pamela Franco
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
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Marcia Machein
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
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Astrid Weyerbrock
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
| Published: | June 2, 2015 |
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Outline
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Objective: Bevacizumab (BEV) is widely used for treatment of patients with recurrent glioblastoma (GBM). Recent studies could not show a positive effect of BEV in first-line therapy of GBM. BEV improved the progression-free-survival (PFS) without prolonging overall survival (OS). Lomustine (CCNU) monotherapy is an approved chemotherapeutical option in recurrent GBM therapy. We examined the outcome of recurrent GBM patients with BEV monotherapy versus BEV/Lomustine therapy.
Method: 50 patients with recurrent GBM that were treated with BEV or BEV/Lomustine between 2010 and 2014 as last line therapy were included in this retrospective study. Progression-free and overall survival was determined with reference to the beginning of BEV or BEV/Lomustine therapy and first diagnosis by RANO criteria. 8 patients were excluded because of missing survival data. 17 patients received BEV monotherapy, 18 patients received combined BEV/Lomustine therapy. The impact of parameters such as IDH mutation, MGMT promoter methylation, tumor localization, histology (primary vs secondary GBM) and the number of surgeries were included in a multivariate ANOVA analysis. In addition, we analyzed the Karnofsky performance score (KPS) and neurological outcome in both patients groups.
Results: BEV/Lomustine treatment led to an extension of PFS of more than 2 months (6.11 months; CL 3.41-12.98; log-rank p=0.00241) and OS (6.59 months; CL 5.51-16.3; log-rank p=0.0238) compared to BEV monotherapy (PSF 2.3 months; 95%CL 1.87-4.39 months; OS 4.07; 95%CL 3.02-6,7 months). This survival advantage was independent of histology, IDH mutation status or the number of previous surgeries. Neurological outcome and KPS did not significantly differ between both treatment groups (one-way ANOVA p=0.38-0.47). Generally, BEV or BEV/Lomustine therapy was equally tolerated and did not present any serious adverse events in our study.
Conclusions: Last line therapy of BEV/Lomustine results in a longer PFS and OS compared to BEV monotherapy in this patient population. These findings confirm the role of these agents in the treatment of recurrent GBM and are in line with observations in other studies. Further studies are needed to identify the subgroup of patients who will benefit from this treatment strategy.
