Bevacizumab In Recurrent Glioma Research Articles

Optimal dose of bevacizumab in recurrent glioma: A retrospective study

Background: Recurrent gliomas have a dismal prognosis. They can be treated with re-surgery and re-irradiation. Bevacizumab as a single agent or in combination with chemotherapy is an alternative treatment option. However, in our country, a considerable proportion of patients cannot afford the approved 10 mg/kg dose. Objective: This study was aimed at evaluating the efficacy of low-dose bevacizumab in recurrent gliomas. Methods: Patients with recurrent gliomas presenting to our Neuro-Medical Oncology unit between July 1, 2015, and November 30, 2018, were retrospectively analyzed. The patients were divided into two groups, those treated with ≤5 mg/kg of bevacizumab (low dose) and those treated with >5–10 mg/kg (standard dose) of bevacizumab. The status of isocitrate dehydrogenase (IDH) and O[6]-methylguanine-DNA methyltransferase was recorded. The primary endpoint of the study was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and adverse events. Results: A total of 68 patients were treated with bevacizumab, of which 23 (33.8%) received the low-dose regimen. At a median follow-up of 26.2 months, there was no difference in the median PFS (low-dose group: 3.60 months; 95% confidence interval [CI], 2.5–7.47 vs. standard-dose group: 3.67 months; 95% CI, 2.17–4.53) (P = 0.18) and median OS (low-dose group: 7.33 months; 95% CI, 3.97–9.10 vs. standard-dose group: 5.47 months; 95% CI, 4.67–6.2) (P = 0.27). In addition, the adverse events were not significantly different between the two groups. Conclusion: Low-dose bevacizumab may be effective in the treatment of recurrent gliomas and should be compared with standard dose in prospective randomized studies.

Bevacizumab in recurrent glioma: Variable doses, volatile benefits

Bevacizumab in recurrent glioma: Variable doses, volatile benefits

Bevacizumab in Recurrent Glioma: Patterns of Treatment Failure and Implications.

Glioblastoma, the most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, has increasingly been used in the treatment of recurrent glioblastoma. It has achieved excellent rates of radiographic response, but most patients will progress after only a few months. Upon recurrence, tumors may not enhance, secondary to vascular normalization. We describe four patterns of radiographic progression commonly associated with Bevacizumab failure: 1) Distant enhancing tumor, 2) Local tumor progression without enhancement, 3) Diffuse gliomatosis-like infiltration, and 4) Local or multifocal progression, with enhancement. Some have noted an increased incidence of distant or diffuse disease upon recurrence, suggestive of a transition to a more aggressive phenotype, but a review of the literature suggests there is no conclusive evidence that Bevacizumab treatment is associated with an increased rate of distant or diffuse recurrence.

AI-22 * CLINICAL OUTCOME OF BEVACIZUMAB-TREATED PATIENTS WITH RECURRENT MALIGNANT GLIOMAS

INTRODUCTION: Currently, there is no standard therapeutic regimen for recurrent gliomas. Bevacizumab is a recombinant anti-vascular endothelial growth factor (anti-VEGF) antibody. After its approval by the US Food and Drug Administration for recurrent glioblastoma, this drug has been an emerging treatment option for recurrent gliomas; however, the European Medicines Agency has rejected the use of bevacizumab for gliomas. METHODS: We retrospectively analyzed the clinical data of bevacizumab-treated recurrent glioma patients in our department. We included 25 patients (20 men, and 5 women) with recurrent malignant gliomas, aged between 18 and 63 years (median, 39 years), who had undergone bevacizumab-based treatment between February 2009 and September 2012. RESULTS: The median follow-up period was 4 months (range, 1-17 months). The median number of bevacizumab cycles that were administered was 6 (range 1-18 cycles). All of the patients showed radiological reduction of gadorinium -enhanced lesion and 20 (83.3%) patients showed improvement of Karnofsky performance score (KPS) after bevacizumab treatment. The overall response rate was 70%. The median progression-free survival (PFS) for the entire group was 3.3 months and the 6-month PFS (PFS-6m) was 20.8%. The median overall survival (OS) and the 1-year OS (OS-1y) for all patients were 6.7 months and 33.2%, respectively. Patients with primary glioblastoma (pGB) had better OS than those with secondary glioblastoma (sGB); the median OS for pGB and sGB were 7.6, and 4.1 months, respectively (P = 0.06). CONCLUSION: Anti-angiogenic therapy using bevacizumab for recurrent gliomas appears to improve patients the activity for daily living for a few months. However, this therapy did not improve patient overall survival. Further, this therapy cannot be recommended for patients with sGB from grade II and grade III gliomas.

Safety and Efficacy of Bevacizumab as a Radiosensitizer in Malignant Glioma: Stereotactic Re-Irradiation for Recurrences as a Pilot for Adjuvant Treatment

Clinical studies of bevacizumab in recurrent glioma have been promising, but the safety of the concurrent use of this drug with brain irradiation has not been studied and will be critical to the widely-anticipated use of this drug as part of the initial treatment regimen. The primary objective of this study is to first determine the safety of this combination in recurrent gliomas, so that it can then be used adjuvantly.