Abstract
Glioblastoma (GBM) is the most common high-grade primary brain tumor in adults. Standard multi-modality treatment of glioblastoma with surgery, temozolomide chemotherapy, and radiation results in transient tumor control but inevitably gives way to disease progression. The need for additional therapeutic avenues for patients with GBM led to interest in anti-angiogenic therapies, and in particular, bevacizumab. We sought to determine the efficacy of bevacizumab as a treatment for newly diagnosed GBM. We conducted a literature search using the PubMed database and Google Scholar to identify randomized controlled trials (RCTs) since 2014 investigating the safety and efficacy of bevacizumab in the treatment of adult patients (18 years and older) with newly diagnosed GBM. Only Level Ι data that reported progression-free survival (PFS) and overall survival (OS) were included for analysis. Random effects meta-analyses on studies with newly diagnosed glioblastoma were conducted in R to estimate the pooled hazard ratio (HR) for PFS and OS. Six RCTs met requirements for meta-analysis, revealing a pooled estimate of PFS HR suggesting a 33% decreased risk of disease progression (HR 0.67, 95% CI, 0.58–0.78; p < 0.001) with bevacizumab therapy, but no effect on OS (HR = 1, 95% CI, 0.85–1.18; p = 0.97). A pooled estimate of the mean difference in OS months of −0.13 predicts little difference in time of survival between treatment groups (95% CI, −1.87–1.61). The pooled estimate for the mean difference in PFS months was 2.70 (95% CI, 1.89–3.50; p < 0.001). Meta-analysis shows that bevacizumab therapy is associated with a longer PFS in adult patients with newly diagnosed glioblastoma, but had an inconsistent effect on OS in this patient population.
Highlights
Glioblastoma (GBM), a subgroup of diffuse gliomas, is the most common high-grade primary brain tumor in adults [1]
Screening for title led to the exclusion of 367 of these citations; the remaining 32 citations were screened for abstract
Seven citations (n = 2,065 patients) met inclusion criteria and were eligible to be included in the qualitative synthesis of this literature review [9,10,13,14,15,16,17] (Table 1); the remaining 25 citations were excluded per the criteria detailed above
Summary
Glioblastoma (GBM), a subgroup of diffuse gliomas, is the most common high-grade primary brain tumor in adults [1]. Survival following diagnosis with GBM remains dismal: median survival is 14–16 months, with only a minority of patients surviving beyond two years [4,5]. The synonymous finding of neoangiogenesis in GBM suggested a possible utility for anti-angiogenic therapies in this disease. While early studies examining BEV in patients with recurrent malignant glioma were promising [6,7,8], the results of multiple randomized control trials (RCTs) examining the role of BEV in the treatment of patients with newly diagnosed GBM failed to show a positive effect of BEV on overall survival (OS) [9,10,11]. The role of BEV in the treatment of patients with newly diagnosed and recurrent GBM remains unclear
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