Abstract
BackgroundThe combination of bevacizumab and irinotecan is a new chemotherapy protocol increasingly used for recurrent malignant glioma. Results from phase II trials suggest this drug combination is beneficial to patients, but no conclusive comparisons between this and other treatment protocols have been published.MethodsWe performed a systematic review and survival gain analysis of phase II studies to evaluate the efficacy and safety of bevacizumab plus irinotecan treatment. To do this, we utilized a preexisting database from which the mean overall survival and response rate of patients could be predicted. Survival gain, which characterized the influence of treatment, was defined as the difference between observed and predicted mean overall survival. Response gain was calculated similarly.Results741 cohorts were enrolled in the database. Among them, 282 cohorts were based on recurrent adult HGG, mean reported median overall survival was 10.96 ± 8.4 months, and mean response rate was 18.9% ± 20.5. We found that compared with other treatment protocols, bevacizumab plus irinotecan largely improved response rates (P = 0.00002) and had a possible moderate effect on overall survival time (P = 0.024). Hemorrhage, thromboembolic complications, and gastrointestinal toxicities were the most frequently reported side effects.ConclusionThe combination of bevacizumab and irinotecan might improve outcome in patients with recurrent malignant glioma. Randomized controlled trials are recommended to evaluate this treatment protocol and the additional value of irinotecan.
Highlights
The combination of bevacizumab and irinotecan is a new chemotherapy protocol increasingly used for recurrent malignant glioma
The following selection criteria were applied: (1) Study population of patients with histologically proven malignant glioma, all of whom had experienced tumor progression that was measurable on magnetic resonance imaging (MRI) and received bevacizumab plus irinotecan as salvage chemotherapy; (2) Study contained information on the diagnosis of recurrent malignant glioma, treatment protocol, criteria for response, responses to treatment, and overall survival or progression-free survival (PFS); (3) The response rates for recurrent
Among the 741 cohorts, 282 cohorts were based on recurrent adult High-grade glioma (HGG), with a mean of median survival time of 10.96 months (SD 8.4 months)
Summary
The combination of bevacizumab and irinotecan is a new chemotherapy protocol increasingly used for recurrent malignant glioma. The standard of care for adult patients with glioblastoma is radiation and temozolomide [2]. This regimen yields median survival times of only 12 to 15 months for patients with newly diagnosed glioblastomas and only 2 to 5 years for patients with newly diagnosed anaplastic gliomas [3]. Irinotecan was proved to have activity against non-glioma malignancies, such as gastrointestinal malignancies [10]. It was regarded as an alternative choice for recurrent HGG despite the controversy regarding its ability to pass through the blood brain barrier. As a single agent, irinotecan showed disappointing results in the treatment of recurrent malignant gliomas [11]
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