Clinical outcomes in recurrent glioblastoma with bevacizumab therapy: An analysis of the literature

• Published in: Journal of clinical neuroscience Vol. 44; pp. 101 - 106
• Main Authors: Tipping, Matthew, Eickhoff, Jens, Ian Robins, H.
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-10-2017
• Subjects: Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - therapeutic use; Bevacizumab; Bevacizumab - administration & dosage; Bevacizumab - adverse effects; Bevacizumab - therapeutic use; Brain Neoplasms - drug therapy; Glioblastoma - drug therapy; Humans; Overall survival; Recurrent glioblastoma; Survival Analysis; Recurrent glioblastoma; Overall survival; Bevacizumab
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2017.06.070

•Bevacizumab (BEV) is a common treatment for recurrent glioblastoma (r-GBM).•Post BEV survival (OS) & progression free survival (PFS) are not well defined.•Post BEV-OS & BEV-PFS were analyzed in r-GBM from 53 arms of 42 clinical trials.•PFS=4.38M (95% CI 4.09–4.68); post-BEV-OS=3.36M (95% CI 3.12–3.66) [n=2045].•These estimates provide a historical control for BEV-PFS & post BEV-OS.
Bevacizumab (BEV) is a common treatment for recurrent glioblastoma (GBM). After progression on BEV, there is no consensus on subsequent therapy, as multiple chemotherapy trials have failed to demonstrate discernible activity for salvage. A previous review (995 patients) estimated a progression free survival (PFS) on BEV of 4.2months (SD±2.1) with an overall survival (OS) after progression on BEV at 3.8months (SD±1). We endeavored to establish a more rigorous historical control, both as a benchmark for efficacy, and a prognostic tool for clinical practice. A comprehensive literature review was performed utilizing PubMed and societal presentation abstracts. A total 2388 patients from 53 arms of 42 studies were analyzed in three groups: 1) thirty-two studies in which survival post-BEV was determined by subtracting PFS from OS (2045 patients): PFS on BEV=4.38months (95% CI 4.09–4.68); OS post-BEV=3.36months (95% CI 3.12–3.66); 2) two studies (94 patients) in which OS post-BEV is reported: OS=3.26 (95% CI 2.39–4.42); 3) eight studies of salvage therapy after progression on BEV (249 patients): of OS post-BEV=4.46months (95% CI 3.68–5.54). These estimates provide a firm historical control for PFS on BEV, as well as OS after disease progression on BEV therapy.