The addition of bevacizumab to conventional therapy in newly diagnosed GBM appears to improve both PFS and OS in patients with newly diagnosed GBM, with acceptable morbidity. A shift toward diffuse relapse was noted in a significant number of patients. Ongoing Phase III clinical trials will show the true benefit of this antiangiogenic approach.

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BackgroundPrimary extranodal marginal zone lymphoma (MZL) of the dura is a rare neoplastic entity in the central nervous system (CNS).MethodsWe used literature searches to identify previously reported cases of primary dural MZL. We also reviewed clinical, pathologic, and radiographic data of an adult patient with concurrent dural MZL and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).ResultsWe identified 104 cases of dural MZL in the literature. None of them presented concurrently with another type of non-Hodgkin lymphoma. This is the first report of composite lymphoma consisting of dural MZL and CLL/SLL in the bone marrow and lymph nodes.ConclusionPrimary dural MZL is a rare, indolent low-grade CNS lymphoma, with a relatively good prognosis. Its treatment is multidisciplinary and often requires surgical intervention due to brain compression, along with low to moderate doses of radiotherapy and/or systemic chemotherapy.

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Presence of diffuse invasive disease not accompanied by angiogenesis either prior to therapy or subsequent to anti-angiogenic therapy does not seem to have prognostic significance. However, invasion accompanied by angiogenesis in newly diagnosed HGG may confer a poor prognosis.

2017 Background: Prognosis of glioblastoma (GBM) is very poor. Standard treatment includes surgical resection (SR), radiation (RT), concomitant and adjuvant chemotherapy with temozolomide (TMZ). Our objective is to assess the treatment efficacy, safety and survival in patients with newly-diagnosed GBM treated with RT, TMZ, and bevacizumab in the upfront management. Methods: From 2006–2008, 51 eligible patients (age >18, KPS >70) with newly-diagnosed GBM divided into two groups. Group A (n = 20) was treated with RT (60Gy) and concomitant TMZ (75mg/m2 daily for 42 days) with bevacizumab (10mg/kg every 2 weeks), 29 days following surgery, followed by up to six cycles of adjuvant TMZ (150mg/m2,daily x 7d, q28 with bevacizumab at 10mg/kg days 8 and 22 of each 28 day cycle. Group B (n = 31) received similar treatment without bevacizumab. Both groups were followed up until tumor progression (PFS). Recurrence was defined according to MacDonald Criteria. The end points were PFS, overall survival (OS) and toxicity. Results: Median bevacizumab infusions were 12 (4–32). Median follow-up was14 months for both groups. 6 months PFS survival in Group A was 77.5% and in Group B was 51.6%. Median PFS in Group A was 17 months compared to 7 months in Group B (p < 0.0001, HR = 0.26). Median OS has not been reached in Group A and was 17 months in Group B. One and 2 year OS were 83% and 57% in Group A compared to 72% and 6.5% in Group B (p = 0.02) ). Post-RT and temodar toxicities include thrombocytopenia (1 patient; Gr 3 and fatigue (3 patient;1 Gr 3), bevacizumab related toxicities with RT include leg ulcer with cellulites (1 patient; Gr 3) and pulmonary embolism with thrombocytopenia (1 patient; Gr 4), hypertension (2 patients; Gr 1), and asymptomatic blood products on MRI (2 patients). Conclusions: Bevacizumab has demonstrated efficacy, acceptable toxicity, improved PFS and OS in the upfront management of GBM. No significant financial relationships to disclose.

Purpose:. Local recurrence (LR) accounts for &gt;90% at the time of relapse in high grade glioma (HGG) following conventional therapy. Anti-angiogenic therapy with bevacizumab has shown impressive radiological and clinical responses in HGG. However, an apparent increase in diffuse invasive relapse (DIR) following therapy necessitated a detailed analysis of pattern of recurrence following therapy. Methods: One hundred and sixty five consecutive patients with HGG, either newly diagnosed (n=75) or recurrent (n= 90) received therapy with bevacizumab at 10 mg/kg every two weeks along with conventional chemotherapy ± involved field radiotherapy. The treatment was continued till the time of disease progression or the patient developed dose limiting toxicity. Treatment evaluation was done with neurological examination and magnetic resonance imaging at base line and every 8 weeks subsequently. Pattern of recurrence and time to relapse were the primary aims of the study. DIR was defined as involvement of multiple lobes ± crossing the midline. Survival was calculated from the start of bevacizumab therapy. Results: With a mean follow-up of 6.8 months (range 1-58), 100 of the 165 patients (60.6%) have relapsed with 76 as DIR and 70 have died. The median progression free survival (PFS) and overall survival (OS) were 5 and 9 months respectively. Of the 62 patients who failed initially as LR, 38 (61.3%) patients subsequently developed DIR. 38/75 (50.7%) patients with newly diagnosed and 38/90 (42.2%) of recurrent HGG failed ultimately as DIR. All 9 patients who presented with multicentric HGG relapsed as DIR. The median OS for the patients who failed as DIR was 9 months Vs 6 months for patients with LR alone (p=0.06). While the hazard risk for LR remained linear over time, the risk of DR increased exponentially with time (R2 = 0.933). Biopsies done on eight of these patients at the time of recurrence showed decreased expression of Olig-2 in 6, increased expression of SDF-1 in 5 and a variable expression of CXCR-4 in 6 patients. No change in expression of HIF-1, p53, PDGF or CD163 was seen. Conclusion: Invasion remains a dominant process in HGG as demonstrated by both imaging and pathology. Angiogenic blockade that results in increased invasiveness of HGG is worrisome and needs to be addressed in future clinical trials. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5336.