Deferred use of bevacizumab for recurrent glioblastoma is not associated with diminished efficacy

Piccioni, David; Selfridge, Julia; Mody, Reema; Chowdhury, Reshmi; Li, Sichen; Lalezari, Shadi; Wawrzynski, James; Quan, Jennifer; Zurayk, Mira; Chou, Arthur P.; Sanchez, Daniel R.; Liau, Linda M.; Ellingson, Benjamin M.; Pope, Whitney B.; Nghiemphu, Phioanh L.; Green, Richard M.; Wang, He-Jing; Yong, William H.; Elashoff, Robert M.; Cloughesy, Timothy F.; Lai, Albert

doi:10.1093/neuonc/nou028

Cited by 51 publications

(25 citation statements)

References 20 publications

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“…63 These findings are supported by previous studies, which collectively have reported median overall survival ranges after bevacizumab initiation to be 8.4–9.1 months when used after first recurrence and 7–9.3 months when used after second recurrence. 33,49,63 …”

Section: Bevacizumab Treatment In Glioblastoma: Current Clinical Indisupporting

confidence: 88%

“…We also know that deferred use of bevacizumab does not diminish efficacy in patients with glioblastoma, indicating that the drug can be considered at any point in the course of disease progression. 63 In a recent study, overall survival and PFS after bevacizumab initiation was similar whether treatment was begun after the first, second, or third recurrence. 63 These findings are supported by previous studies, which collectively have reported median overall survival ranges after bevacizumab initiation to be 8.4–9.1 months when used after first recurrence and 7–9.3 months when used after second recurrence.…”

Section: Bevacizumab Treatment In Glioblastoma: Current Clinical Indimentioning

confidence: 95%

“…63 In a recent study, overall survival and PFS after bevacizumab initiation was similar whether treatment was begun after the first, second, or third recurrence. 63 These findings are supported by previous studies, which collectively have reported median overall survival ranges after bevacizumab initiation to be 8.4–9.1 months when used after first recurrence and 7–9.3 months when used after second recurrence. 33,49,63 …”

Section: Bevacizumab Treatment In Glioblastoma: Current Clinical Indimentioning

confidence: 95%

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Bevacizumab for glioblastoma: current indications, surgical implications, and future directions

Castro¹,

Aghi²

2014

FOC

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Initial enthusiasm after promising Phase II trials for treating recurrent glioblastomas with the antiangiogenic drug bevacizumab—a neutralizing antibody targeting vascular endothelial growth factor—was tempered by recent Phase III trials showing no efficacy for treating newly diagnosed glioblastomas. As a result, there is uncertainty about the appropriate indications for the use of bevacizumab in glioblastoma treatment. There are also concerns about the effects of bevacizumab on wound healing that neurosurgeons must be aware of. In addition, biochemical evidence suggests a percentage of tumors treated with bevacizumab for an extended period of time will undergo transformation into a more biologically aggressive and invasive phenotype with a particularly poor prognosis. Despite these concerns, there remain numerous examples of radiological and clinical improvement after bevacizumab treatment, particularly in patients with recurrent glioblastoma with limited therapeutic options. In this paper, the authors review clinical results with bevacizumab for glioblastoma treatment to date, ongoing trials designed to address unanswered questions, current clinical indications based on existing data, neurosurgical implications of bevacizumab use in patients with glioblastoma, the current scientific understanding of the tumor response to short- and long-term bevacizumab treatment, and future studies that will need to be undertaken to enable this treatment to fulfill its therapeutic promise for glioblastoma.

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Section: Bevacizumab Treatment In Glioblastoma: Current Clinical Indisupporting

confidence: 88%

Section: Bevacizumab Treatment In Glioblastoma: Current Clinical Indimentioning

confidence: 95%

Section: Bevacizumab Treatment In Glioblastoma: Current Clinical Indimentioning

confidence: 95%

See 1 more Smart Citation

Bevacizumab for glioblastoma: current indications, surgical implications, and future directions

Castro¹,

Aghi²

2014

FOC

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“…However, all patients received standard therapy with radiation treatment and temozolomide, and recent data suggest that bevacizumab (which some patients received), while potentially prolonging progression-free survival by several months, has little impact on survival time. 33 Thus, the overall impact of therapy variability may be limited. Our study was also limited by a small sample size, reducing our ability to detect a potentially significant difference in overall survival (not merely progressionfree survival) between patient cohorts.…”

Section: Discussionmentioning

confidence: 99%

Arterial Spin-Labeling Perfusion MRI Stratifies Progression-Free Survival and Correlates with Epidermal Growth Factor Receptor Status in Glioblastoma

Qiao¹,

Ellingson²,

Kim³

et al. 2014

AJNR Am J Neuroradiol

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“…Another recent study of 100–150 mg/m 2 given weekly on alternate weeks demonstrated a PFS6 of 29% and an ORR of 8%, but reported 56% with grade 3/4 lymphopenia [25]. Although activity was not a primary end point in either study, when compared with bevacizuma, the PFS6 is lower [26]. …”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of safety and feasibility of a 3 days on/11 days off temozolomide dosing regimen in recurrent adult malignant gliomas

et al. 2014

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SUMMARY Aims We report the safety and feasibility of a 3 days on/11 days off temozolomide regimen for the treatment of recurrent malignant gliomas. Patients & methods Fifteen adult patients were treated; 14 were treated with 300 mg/m2 and one treated with 250 mg/m2. Results We reviewed the toxicity, progression-free survival (PFS), overall survival and objective response rate. Two patients (13%) experienced grade 3 nausea/vomiting and six patients (40%) experienced grade 3 lymphopenia. Dose reduction and treatment delay occurred in eight (53%) cases. One patient discontinued treatment due to uncontrolled nausea/vomiting. Median PFS for glioblastoma patients was 4.1 months and 6-month PFS was 25%. Twelve patients exhibited stable disease (86%), one patient (7%) had progressive disease and one patient (7%) showed a partial response. Conclusion The ‘3 on/11 off’ temozolomide regimen for recurrent high-grade gliomas was tolerable and warrants further study in a larger, prospective study.

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Deferred use of bevacizumab for recurrent glioblastoma is not associated with diminished efficacy

Cited by 51 publications

References 20 publications

Bevacizumab for glioblastoma: current indications, surgical implications, and future directions

Bevacizumab for glioblastoma: current indications, surgical implications, and future directions

Arterial Spin-Labeling Perfusion MRI Stratifies Progression-Free Survival and Correlates with Epidermal Growth Factor Receptor Status in Glioblastoma

Retrospective analysis of safety and feasibility of a 3 days on/11 days off temozolomide dosing regimen in recurrent adult malignant gliomas

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