Antiangiogenic therapy using bevacizumab in recurrent high-grade glioma: impact on local control and patient survival

Ashwatha Narayana, Patrick Kelly, John Golfinos, Erik Parker, Glyn Johnson, Edmond Knopp, David Zagzag, Ingeborg Fischer, Shahzad Raza, Praveen Medabalmi, Patricia Eagan, Michael L. Gruber

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Abstract

OBJECT: Antiangiogenic agents have recently shown impressive radiological responses in high-grade glioma. However, it is not clear if the responses are related to vascular changes or due to antitumoral effects. The authors report the mature results of a clinical study of bevacizumab-based treatment of recurrent high-grade gliomas. METHODS: Sixty-one patients with recurrent high-grade gliomas received treatment with bevacizumab at 10 mg/ kg every 2 weeks for 4 doses in an 8-week cycle along with either irinotecan or carboplatin. The choice of concomitant chemotherapeutic agent was based on the number of recurrences and prior chemotherapy. RESULTS: At a median follow-up of 7.5 months (range 1-19 months), 50 (82%) of 61 patients relapsed and 42 patients (70%) died of the disease. The median number of administered bevacizumab cycles was 2 (range 1-7 cycles). The median progression-free survival (PFS) and overall survival (OS) were 5 (95% confidence interval [CI] 2.3-7.7) and 9 (95% CI 7.6-10.4) months, respectively, as calculated from the initiation of the bevacizumab-based therapy. Radiologically demonstrated responses following therapy were noted in 73.6% of cases. Neither the choice of chemotherapeutic agent nor the performance of a resection prior to therapy had an impact on patient survival. Although the predominant pattern of relapse was local, 15 patients (30%) had diffuse disease. CONCLUSIONS: Antiangiogenic therapy using bevacizumab appears to improve survival in patients with recurrent high-grade glioma. A possible change in the invasiveness of the tumor following therapy is worrisome and must be closely monitored.
Original languageEnglish
Pages (from-to)173-180
JournalJournal of Neurosurgery
Volume110
Issue number1
DOIs
Publication statusPublished - Jan 2009

Keywords

  • antiangiogenic therapy
  • bevacizumab
  • high-grade glioma

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