Abstract
Abstract INTRODUCTION Anaplastic oligodendroglioma (AO) is a rare high-grade glioma. Standard of care include resection, radiotherapy followed by chemotherapy. However, effective treatment for recurrent AO is limited. Here we report pembrolizumab (Pembro) + bevacizumab (Bev) therapy for recurrent AO. CASE A 55-year-old male had a brain mass discovered on MRI in 2012 and received no treatment until resection in 2014. He underwent second tumor resection in late 2016 and pathology demonstrated an AO, WHO grade 3. He received radiation followed by PCV regimen in 2017. Ten months later in March 2018, he had tumor progression on PCV. Temozolomide was started. Two months later, Bev (10 mg/kg) was initiated in May 2018 due to further progression. After 12 months of Bev therapy, in mid-2019, Pembro was added due to new and enlarged lesions on MRI. After 18 months of q-3-week Bev (10mg/kg) + Pembro, Bev was on hold in December 2020 due to multiple TIAs. Single agent Pembro was continued for 6 months until April 2021 when his brain MRI showed increased enhancement. Then q-3-week Bev was resumed at a reduced dose (7.5mg/kg). These dual agents continued for 14 months until June 2022 when Bev dose was further reduced to 5mg/kg due to side effect. Bev was on hold again in December 2022 due to high Urine Protein/Creatinine ratio. Single agent Pembro was continued until May 2023 when lower dose Bev (2.5mg/kg) was resumed after MRI showed one subcentimeter new lesion. The small lesion is stable again on q-3-week 2.5 mg/kg Bev+Pembro. The patient has been clinically functional on Bev+Pembro treatment. DISCUSSION Four years of adjuvant pembrolizumab and tailored dose of bevacizumab have resulted in long term repeated stabilization of recurrent AO. The dose and duration of bevacizumab use need to be tailored to minimize adverse effects and to maintain positive effects.
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