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Abstract
Background: Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, may have activity in recurrent malignant gliomas. At recurrence some patients appear to develop nonenhancing infiltrating disease rather than enhancing tumor.
Methods: We retrospectively reviewed 55 consecutive patients with recurrent malignant gliomas who received bevacizumab and chemotherapy to determine efficacy, toxicity, and patterns of recurrence. Using a blinded, standardized imaging review and quantitative volumetric analysis, the recurrence patterns of patients treated with bevacizumab were compared to recurrence patterns of 19 patients treated with chemotherapy alone.
Results: A total of 2.3% of patients had a complete response, 31.8% partial response, 29.5% minimal response, and 29.5% had stable disease. Median time to radiographic progression was 19.3 weeks. Six-month progression-free survival (PFS) was 42% for patients with glioblastoma and 32% for patients with anaplastic glioma. In 23 patients who progressed on their initial therapy, bevacizumab was continued and the concurrent chemotherapy agent changed. In no case did the change produce a radiographic response, but two patients had prolonged PFS of 20 and 31 weeks. Recurrence pattern analysis identified a significant increase in the volume of infiltrative tumor relative to enhancing tumor in bevacizumab responders.
Conclusions: Combination therapy with bevacizumab and chemotherapy is well-tolerated and active against recurrent malignant gliomas. At recurrence, continuing bevacizumab and changing the chemotherapy agent provided long-term disease control only in a small subset of patients. Bevacizumab may alter the recurrence pattern of malignant gliomas by suppressing enhancing tumor recurrence more effectively than it suppresses nonenhancing, infiltrative tumor growth.
Glossary
- AA=
- anaplastic astrocytoma;
- AG=
- anaplastic glioma;
- CR=
- complete response;
- GBM=
- glioblastoma;
- EIAED=
- enzyme-inducing antiepileptic drug;
- FLAIR=
- fluid-attenuated inversion recovery;
- KPS=
- Karnofsky Performance Status;
- MR=
- minimal response;
- PFS=
- progression-free survival;
- PR=
- partial response;
- rFPR=
- relative FLAIR progression ratio;
- rNTR=
- relative nonenhancing tumor ratio;
- T1W=
- T1-weighted;
- VEGF=
- vascular endothelial growth factor.
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- Bevacizumab for recurrent malignant gliomas: Efficacy, toxicity, and patterns of recurrence
- Bevacizumab for recurrent malignant gliomas: Efficacy, toxicity, and patterns of recurrence
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