Safety and efficacy of hypofractionated stereotactic radiosurgery with anlotinib targeted therapy for glioblastoma at first recurrence: A preliminary report.

Abstract

e14015 Background: The optimal treatment for recurrent glioblastoma (rGBM) remains uncertain. Hypofractionated stereotactic radiotherapy (HSRT) and anti-vascular endothelial growth factor (VEGF) antibodies (e.g, bevacizumab and anlotinib) have been reported a promising survival benefit and acceptable toxicity in recent studies. This research aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery with anlotinib as a salvage treatment for rGBM within the radiation field at first recurrence. Methods: Between December 2019 and June 2020, rGBM patients treated with CyberKnife (CK) radiosurgery concurrently with anlotinib were retrospectively analyzed. Anlotinib was prescribed 12 mg daily during CK. Adjuvant anlotinib was administered 12mg d1-14 every 3 weeks. The primary endpoint was objective response rate (ORR) using response assessment in neuro-oncology (RANO) criteria, and secondary endpoints included overall survival (OS), progression-free survival (PFS) after salvage treatment, and toxicity. Toxicity was assessed using common terminology criteria for adverse events (CTCAE) 5.0. Results: A total of five patients were included in the study. The median planning target volume (PTV) was 26.94 cm3 (5.53 to 54.41 cm3). The prescribed dose was 25.0 Gy in 5 fractions. The median number of cycles of anlotinib was 9 (4 to 15 cycles). The median baseline Karnofsky Performance Status (KPS) is 80 (70 to 90). The follow-up ranged from 4 to 10 months. Three (60%) patients had the best outcome of partial response (PR), and 2 (40%) achieved complete response (CR), the ORR was 100%. No patient died or had progressive disease (PD) until the last follow-up. Two patients had grade 2 hand-foot syndrome and relieved after dermatology treatments, no other grade 3 or higher toxicities was recorded. Conclusions: Salvage radiosurgery with anlotinib showed a favorable outcome and acceptable toxicity for rGBM patients in this preliminary report. A prospective phase II study (NCT04197492) is ongoing to further investigate the regimen in rHGG. [Table: see text]