Survival in elderly glioblastoma patients treated with bevacizumab-based regimens in the United States

Abstract

Background The efficacy of bevacizumab (BEV) in elderly patients with glioblastoma remains unclear. We evaluated the effect of BEV on survival in this patient population using the Survival, Epidemiology, and End Results (SEER)-Medicare database. Methods This retrospective, cohort study analyzed SEER-Medicare data for patients (aged ≥66 years) diagnosed with glioblastoma from 2006 to 2011. Two cohorts were constructed: one comprised patients who had received BEV (BEV cohort); the other comprised patients who had received any anticancer treatment other than BEV (NBEV cohort). The primary analysis used a multivariate Cox proportional hazards model to compare overall survival in the BEV and NBEV cohorts with initiation of BEV as a time-dependent variable, adjusting for potential confounders (age, gender, Charlson comorbidity index, region, race, radiotherapy after initial surgery, and diagnosis of coronary artery disease). Sensitivity analyses were conducted using landmark survival, propensity score modeling, and the impact of poor Karnofsky Performance Status. Results We identified 2603 patients (BEV, n = 597; NBEV, n = 2006). In the BEV cohort, most patients were Caucasian males and were younger with fewer comorbidities and more initial resections. In the primary analysis, the BEV cohort showed a lower risk of death compared with the NBEV cohort (hazard ratio, 0.80; 95% confidence interval, 0.72–0.89; P < .01). The survival benefit of BEV appeared independent of the number of temozolomide cycles or frontline treatment with radiotherapy and temozolomide. Conclusion BEV exposure was associated with a lower risk of death, providing evidence that there might be a potential benefit of BEV in elderly patients with glioblastoma.

Clinical features associated with the efficacy of chemotherapy in patients with glioblastoma (GBM): a surveillance, epidemiology, and end results (SEER) analysis

“…Bevacizumab (BEV), another U.S. Food and Drug Administration (FDA) approved drug, is widely used for treatment in recurrent GBM. The survival benefits of TMZ and BEV have been widely explored in the clinical trials [8][9][10][11][12] and retrospective studies [13][14][15][16][17][18][19]. And, second-line chemotherapy options include nitrosoureas, lomustine, cyclophosphamide, irinotecan, and platinumbased regimens, etc.…”

Glioblastoma and bevacizumab in elderly patients: Monocentric study

“…Among the factors affecting the clinical prognosis, advanced age and poor general condition have always been associated with shorter global survival. 5–9…”

“…The poor prognosis and relative lack of clinical trials in elderly patients have led to uncertainty as to the optimal management of this group of patients. 9–13 The treatment decision in elderly patients can be difficult given other factors such as co-morbidities, co-medications and an increased susceptibility to side effects. In addition, the social and economic vulnerability typical of this type of population adds to said difficulty.…”

Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study

“…A population-based study showed older adults receive bevacizumab, a common treatment at recurrence, at much lower rates relative to the broader GBM population, although the patients who received bevacizumab experienced significantly improved survival. 15 …”