Abstract
Clinical studies treating pediatric and adult solid tumors, such as glioblastoma (GBM), with a triple-drug regimen of temozolomide (TMZ), bevacizumab (BEV), and irinotecan (IRI) [TBI] have demonstrated various efficacies, but with no unexpected toxicities. The TBI regimen has never been studied in recurrent GBM (rGBM) patients. In this retrospective study, we investigated the outcomes and side effects of rGBM patients who had received the TBI regimen. We identified 48 adult rGBM patients with a median age of 56 years (range: 26–76), who received Tumor Treating Fields (TTFields) treatment for 30 days or longer, and concurrent salvage chemotherapies. The patients were classified into two groups based on chemotherapies received: TBI with TTFields (TBI+T, N = 18) vs. bevacizumab (BEV)-based chemotherapies with TTFields (BBC+T, N = 30). BBC regimens were either BEV monotherapy, BEV+IRI or BEV+CCNU. Patients in TBI+T group received on average 19 cycles of TMZ, 26 and 21 times infusions with BEV and IRI, respectively. Median overall survival (OS) and progression-free survival (PFS) for rGBM (OS-R and PFS-R) patients who received TBI+T were 18.9 and 10.7 months, respectively. In comparison, patients who received BBC+T treatment had OS-R and PFS-R of 11.8 (P > 0.05) and 4.7 (P < 0.05) months, respectively. Although the median PFS results were significantly different by 1.5 months (6.6 vs. 5.1) between TBI+T and BBC+T groups, the median OS difference of 14.7 months (32.5 vs. 17.8) was more pronounced, P < 0.05. Patients tolerated TBI+T or BBC+T treatments well and there were no unexpected toxicities. The most common side effects from TBI+T treatment included grade III hypertension (38.9%) and leukopenia (22.2%). In conclusion, the TBI regimen might play a role in the improvement of PFS-R and OS-R among rGBM patients. Prospective studies with a larger sample size are warranted to study the efficacy and toxicity of TBI+T regimen for rGBM.
Highlights
Glioblastoma (GBM) is the most common and devastating primary malignant brain tumor in adults [1, 2]
Forty patients were from Mischer Neuroscience Institute (MNI) and eight patients were from Baylor Scott and White Health (BSWH)
N (%) 0 (0%) 1 (5.6%) 0 (0%) 0 (0%) 7 (38.9%) 1 (5.6%) 4 (22.2%) 0 (0%) 3 (16.7%) 1 (5.6%) 4 (22.2%) 1 (5.6%) 1 (5.6%) 2 (11.1%) 2 (11.1%). This retrospective study demonstrated that TBI+T treatment (N = 18) for recurrent GBM (rGBM) resulted in longer median overall survival (OS) and PFSR than patients in the BEV-based chemotherapy (BBC)+T group, P < 0.05
Summary
Glioblastoma (GBM) is the most common and devastating primary malignant brain tumor in adults [1, 2]. The VEGF pathway can be inhibited by bevacizumab (BEV), a humanized monoclonal antibody binding to circulating VEGF-A which received accelerated approval by the United States Food and Drug Administration (FDA) for the treatment of recurrent GBM (rGBM) in May 2009 based on results from two phase II trials [3, 4]. Administration of BEV along with TMZ as an adjuvant treatment for newly diagnosed GBM did not improve median overall survival (OS) when compared to patients that received TMZ monotherapy [5, 6]. The EF-14 phase III clinical trial (NCT00916409) using TTFields along with maintenance TMZ prolonged median OS to 20.9 months, which was superior to a median OS of 16.0 months in the control group treated with TMZ monotherapy for newly diagnosed GBM [12]. Based on an analysis of populationbased databases, the median OS in the general GBM population is between 8 and 11 months [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
