Recurrent Oligodendroglioma: Treatment with Bevacizumab

Abstract

A retrospective literature review of bevacizumab with or without a cytotoxic partner in adults with recurrent anaplastic oligodendroglioma (AO) or oligoastrocytoma (AOA). There is no standard therapy for alkylator-resistant AO/AOA and hence a need exists for new therapies. Six papers were eligible for inclusion following a literature review in which 150 patients’ with recurrent anaplastic gliomas (47 [31%] were AO/AOA) were treated with bevacizumab. All patients had previously been treated with surgery, radiotherapy, and temozolomide-based chemotherapy. Patients were treated at first, second or third recurrence with bevacizumab, once every 2 weeks, defined as a single cycle. The majority of patients (25/47 AO/AOA; 53%) were treated with a cytotoxic chemotherapy (predominantly irinotecan) as well. The results indicated that bevacizumab-related toxicity included fatigue, epistaxis, intracranial hemorrhage, proteinuria, hypertension, deep vein thrombosis and wound dehiscence. Myelosuppression was ascribed to concomitant cytotoxic chemotherapy. 34–73% (median 68%) of all anaplastic gliomas (AG) patients demonstrated a radiographic response (complete in 11%; partial in 56%), stable disease pattern in 5–59% (median 16%) and progressive disease in 6–28% (median 9.5%) following two cycles of bevacizumab. Median, 6-month and 12-month progression free survival was 26 weeks (range 17–35), 49.5% (range 32–68%) and 23.5% (range 16–39%) respectively. In conclusion, bevacizumab, with or without a cytotoxic chemotherapy partner, demonstrates efficacy and acceptable toxicity in adults with recurrent AO/AOA.