Bevacizumab in recurrent high-grade glioma: a single institution retrospective analysis on 92 patients

Abstract

Background High-grade gliomas are among the most aggressive central nervous system primary tumors, with a high risk of recurrence and a poor prognosis. Re-operation, re-irradiation, chemotherapy are options in this setting. No-best therapy has been established. Bevacizumab was approved on the basis of two Phase 2 trials that evaluated its efficacy in patients with recurrent glioblastoma. Materials and methods We have retrospectively review data of patients with high-grade glioma treated at our institution that undergone radiological or histological progression after at least one systemic treatment for recurrent disease. Bevacizumab was administered alone or in combination with chemotherapy until disease progression or unacceptable toxicity. Bevacizumab regimen was analyzed to assess PFS and OS. Histological, molecular and clinical features of the entire cohort were collected. Results We reviewed data from 92 patients, treated from April 2009 to November 2019, with histologically confirmed diagnosis of high-grade gliomas and recurrent disease. A PFS of 55.2%, 22.9% and 9.6% was observed at 6, 12 and 24 months, respectively. Performance status, age at diagnosis (< 65 or > 65 ys.) and use of corticosteroids during bevacizumab therapy were strongly associated with PFS. The OS was 74.9% at 6 months, 31.7% at 12 months, 10.1% at 24 months. In our cohort, 51.1% were long-term responders (PFS > 6 months). Globally, bevacizumab treatment was well tolerated. Conclusion Our analysis confirms the efficacy of bevacizumab in recurrent high-grade glioma patients with an acceptable toxicity profile, in keeping with its known safety in the literature.

Glioblastoma Treatment: State-of-the-Art and Future Perspectives

“…Particularly in the recurrence setting, BEV presented response rates of approximately 30% in uncontrolled phase II trials [43]. About co-adjuvant chemotherapy with BEV, a randomized phase III trial tested the combination of BEV + lomustine versus lomustine alone, and results showed an improvement in PFS without OS changes in the combination group [44][45][46].…”

“…The IL13 monomer IL-13Rα2 is a cancer germline antigen that has activity in the PI3K/AKT/mTOR pathway, expressed in approximately 75% of GB and associated with a worse prognosis [44,47]. Brown et al have studied the utility of IL-13Rα2-specific CAR T cells, observing a safe profile without significant positive results.…”

Radiotherapy of High-Grade Gliomas: First Half of 2021 Update with Special Reference to Radiosensitization Studies

“…Bevacizumab was approved for recurrent HGG on the basis of two phase 2 trials that evaluated its efficacy in patients with recurrent GB [56]. In 2014, two phase 3 trials revealed improved PFS, but not OS, after bevacizumab therapy combined to RT-TMZ [57,58].…”

“…In 2014, two phase 3 trials revealed improved PFS, but not OS, after bevacizumab therapy combined to RT-TMZ [57,58]. Recent analyses on limited groups of patients confirmed the efficacy of bevacizumab in improving the PFS of recurrent HGG patients with an acceptable toxicity profile [56,59]. Currently, the combination of re-irradiation with bevacizumab for recurrent HGG is common, but its efficacy is highly variable.…”

Filamentous Bacteriophage—A Powerful Carrier for Glioma Therapy

“…At present, the clinical therapies for gliomas are surgical therapy, radiation therapy, chemotherapy, gene therapy, and other comprehensives (1,(71)(72)(73)(74). However, it is easy to relapse after these treatments, and the patients' survival rates are not significantly improved.…”