Abstract
BackgroundAssess benefit of salvage bevacizumab (BEV) at time of symptomatic progression in patients with refractory glioblastoma (GBM).MethodsPatients managed with adjuvant long course chemo-radiation therapy for GBM were entered into a prospective database. At chemorefractory symptomatic progression, patients were offered BEV or best supportive care. Re-irradiation (ReRT) was used with BEV in selected patients. BEV continued indefinitely until deterioration limited hospital based infusion.The primary endpoint was median survival calculated from date of decision for BEV to proceed (BEVstart), or decision to decline BEV (BEVreject).ResultsFifty-five patients were managed of which 48 patients have relapsed disease. The median survival post relapse was 6 months (95%CI: 4.6–7.4). At relapse, 28 patients received BEV with only 14% delivered at first relapse. The median number of BEV cycles was 8 (range 1–25). ReRT was subsequently used in 16 (33%) relapsed patients. BEV treated patients were associated with improved median survival post relapse with 9 months vs 3 months (p < 0.01).The median survival from BEV related decision-making at symptomatic refractory progression to death was 4 months (95%CI: 2.0–6.0). BEVstart was associated with improved survival from this date with median survival of 6 months vs 1 month with BEVreject (p < 0.01). Median survival with ReRT from this date was 8 months vs 3 months without ReRT (p = 0.01). In the BEV patients at eventual progression, death occurred at a median of 30 days post BEV cessation.ConclusionIn this clinic managing selected patients with chemorefractory progressive glioblastoma, delayed salvage bevacizumab, often in combination with re-irradiation, may provide an increase in survival duration compared with best supportive care.
Highlights
Assess benefit of salvage bevacizumab (BEV) at time of symptomatic progression in patients with refractory glioblastoma (GBM)
This study demonstrates that salvage BEV at time of chemorefractory disease for GBM may provide a median 5 months additional survival and a 25% chance of being alive at 9 months post commencement
This compares with best supportive care at the same period which resulted in deterioration and a median survival of 4 weeks
Summary
Assess benefit of salvage bevacizumab (BEV) at time of symptomatic progression in patients with refractory glioblastoma (GBM). Cuncannon et al BMC Cancer (2019) 19:445 of data regarding magnitude of benefit over best supportive care [5] This is in the presence of a therapy which may have significant financial cost as well as exposing patients to risk of morbidity. This current study undertaken in a regional cancer centre explores a policy in the care of patients with recurrent GBM of delaying monotherapy BEV until time of symptomatic chemorecfratory disease at either second or later relapse after salvage systemic therapy [10]
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