Glioblastoma and bevacizumab in elderly patients: Monocentric study

Barrascout, Eduardo; Lamuraglia, Michele

doi:10.1177/1078155220940396

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…In a retrospective study, the efficacy and safety of bevacizumab in recurrent glioblastoma appear similar in elderly and non-elderly patients. However, the clinical benefit seemed less evident in younger patients ( 68 ).…”

Section: Managements Of Recurrencementioning

confidence: 97%

Optimal managements of elderly patients with glioblastoma

Arakawa

Mineharu

Uto

et al. 2022

Japanese Journal of Clinical Oncology

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Optimizing the management of elderly patients with glioblastoma is an ongoing task in neuro-oncology. The number of patients with this tumor type is gradually increasing with the aging of the population. Although available data and practice recommendations remain limited, the current strategy is maximal safe surgical resection followed by radiotherapy in combination with temozolomide. However, survival is significantly worse than that in the younger population. Surgical resection provides survival benefit in patients with good performance status. Hypofractionated radiotherapy decreases toxicities while maintaining therapeutic efficacy, thus improving treatment adherence and subsequently leading to better quality of life. The intensity of these treatments should be balanced with patient-specific factors and consideration of quality of life. This review discusses the current optimal management in terms of efficacy and safety, as well as future perspectives.

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Section: Managements Of Recurrencementioning

confidence: 97%

Optimal managements of elderly patients with glioblastoma

Arakawa

Mineharu

Uto

et al. 2022

Japanese Journal of Clinical Oncology

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“… [ 72 ] Age groups 2009, Nghiemphu et al Retrospective study rGBM 123 (100%) BEV combined therapy BEV containing regimen vs. non-BEV regimen BEV treatment reflected a significant increase in PFS and OS, compared with the control group [ 99 ] 2021, Barrascout et al Retrospective study rGBM 47 (100%) BEV monotherapy BEV Significant improvement based on the KPS scale was observed in non-elderly patients. [ 48 ] Laboratory examinations 2016, Bertaut et al Retrospective study rGBM 265 (100%) BEV-containing regimen BEV-containing regimen Only patients with a high neutrophil count (> 6 G/L) benefited from the BEV-containing regimens. [ 100 ] 2019 Quillien et al Prospective study rGBM 29 (100%) BEV monotherapy BEV Low neutrophil counts (< 3.9 G/L) and high Treg counts (above 0.011 G/L) had prolonged OS.…”

Section: Resultsmentioning

confidence: 99%

“…No consensus was found regarding the association between BEV efficacy and age groups. Two retrospective studies found that there was a better improvement in non-elderly patients with rGBM/recurrent high-grade glioma (rHGG) patients compared with elderly patients treated with BEV-containing regimens [ 47 , 48 ]. However, another retrospective study concluded controversially that elderly patients had more prognostic benefits compared with younger patients [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

Use of Bevacizumab in recurrent glioblastoma: a scoping review and evidence map

Zhou

Huang

et al. 2023

BMC Cancer

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Background Glioblastoma (GBM) is the most malignant primary tumor in the brain, with poor prognosis and limited effective therapies. Although Bevacizumab (BEV) has shown promise in extending progression-free survival (PFS) treating GBM, there is no evidence for its ability to prolong overall survival (OS). Given the uncertainty surrounding BEV treatment strategies, we aimed to provide an evidence map associated with BEV therapy for recurrent GBM (rGBM). Methods PubMed, Embase, and the Cochrane Library were searched for the period from January 1, 1970, to March 1, 2022, for studies reporting the prognoses of patients with rGBM receiving BEV. The primary endpoints were overall survival (OS) and quality of life (QoL). The secondary endpoints were PFS, steroid use reduction, and risk of adverse effects. A scoping review and an evidence map were conducted to explore the optimal BEV treatment (including combination regimen, dosage, and window of opportunity). Results Patients with rGBM could gain benefits in PFS, palliative, and cognitive advantages from BEV treatment, although the OS benefits could not be verified with high-quality evidence. Furthermore, BEV combined therapy (especially with lomustine and radiotherapy) showed higher efficacy than BEV monotherapy in the survival of patients with rGBM. Specific molecular alterations (IDH mutation status) and clinical features (large tumor burden and double-positive sign) could predict better responses to BEV administration. A low dosage of BEV showed equal efficacy to the recommended dose, but the optimal opportunity window for BEV administration remains unclear. Conclusions Although OS benefits from BEV-containing regimens could not be verified in this scoping review, the PFS benefits and side effects control supported BEV application in rGBM. Combining BEV with novel treatments like tumor-treating field (TTF) and administration at first recurrence may optimize the therapeutic efficacy. rGBM with a low apparent diffusion coefficient (ADCL), large tumor burden, or IDH mutation is more likely to benefit from BEV treatment. High-quality studies are warranted to explore the combination modality and identify BEV-response subpopulations to maximize benefits.

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“…Bevacizumab is not recommended for people with newly diagnosed glioblastoma due to high rates of adverse events and no improvement in overall survival [79][80][81]. In select cases, bevacizumab may be cautiously used to treat tumor-related edema and to avoid the side-effects of steroids.…”

Section: Chemotherapymentioning

confidence: 99%

Glioblastoma in Elderly Population

Santiago¹,

Borghei-Razavi²,

Mandel³

et al. 2023

Glioblastoma - Current Evidence

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Glioblastoma (GBM) is the third most common primary intracranial tumor and the commonest primary malignant brain tumor in adults. The peak incidence is between 65 and 84 years old. The incidence of GBM increases starkly with age—from 1.3/100,000 between the ages of 35–44 to 15.3/100,000 between the ages of 75–84 years. Elderly patients with GBM have increased comorbidities, lower functional status, aggressive tumor biology, and an overall worse outcome as compared with their younger counterparts. Age is an independent and powerful prognosticator of GBM outcomes, even if the performance status is controlled. Elderly patients with GBM represent a vulnerable heterogeneous cohort. Surgical resection in elderly patients offers a better outcome and improved quality of life as compared with biopsy alone and nowadays can be safely tolerated by elderly patients in specialized centers. The standard of care treatment of glioblastoma based on the Stupp’s protocol excluded patients over the age of 70. Thus, the standard of care treatment in elderly patients with GBM remains controversial. Selected elderly patients with excellent performance status may be treated with Stupp’s protocol. Elderly patients with lower functional status may be treated with a hypofractionated treatment regimen with concomitant and adjuvant temozolomide. Frail patients with MGMT methylated tumor can be treated with temozolomide monotherapy alone. It is also not unreasonable to treat elderly frail patients with MGMT unmethylated GBM with hypofractionated RT alone. Thus, treatment of elderly patients with GBM needs a multidisciplinary approach based on the extent of the tumor, MGMT methylation status, performance status, and even the social situation unique to the elderly patient. This chapter seeks to bring a comprehensive and updated review on the treatment of glioblastoma in the elderly population.

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Glioblastoma and bevacizumab in elderly patients: Monocentric study

Cited by 5 publications

References 18 publications

Optimal managements of elderly patients with glioblastoma

Optimal managements of elderly patients with glioblastoma

Use of Bevacizumab in recurrent glioblastoma: a scoping review and evidence map

Glioblastoma in Elderly Population

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