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

Clinical article

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  • 1 Departments of Radiation Oncology,
  • 2 Neurosurgery,
  • 3 Radiology,
  • 4 Pathology,
  • 5 Biostatistics, and
  • 6 Neuro-Oncology, New York University Medical Center, New York, New York; and
  • 7 Atlantic Health System, Overlook Hospital, Summit, New Jersey
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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.

Abbreviations used in this paper: CI = confidence interval; GBM = glioblastoma multiforme; GTR = gross-total resection; KPS = Karnofsky Performance Scale; OS = overall survival; PFS = progression-free survival; VEGF = vascular endothelial growth factor; WHO = World Health Organization.

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Contributor Notes

Address correspondence to: Ashwatha Narayana, M.D., Department of Radiation Oncology, New York University Medical Center, 550 First Avenue, New York, New York 11016. email: ashwatha.narayana@nyumc.org.

Please include this information when citing this paper: published online October 3, 2008; DOI: 10.3171/2008.4.17492.

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