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Bevacizumab (Avastin) as first-line therapy for glioblastoma.

Al's Comment:

 This article is based on smaller and earlier trials of adding Avastin to the standard of care for glioblastomas.  They report an improvment in progression free survival, but only a small improvement in overall survival.    We are eagerly awaiting the results of a much larger study - hopefully in 2-3 months - to clarify how best to use Avastin - either right at the start after radiation or wait until recurrence.  Right now we really do not know which way is best.

Having said that, an improvement in progression free survival is still very important. It means that you can function and enjoy life for a longer time, and that is priceless.

Posted on: 09/04/2012

Future Oncol. 2012 Aug;8(8):929-38.

Bevacizumab (Avastin) as first-line therapy for glioblastoma.

Piccioni D, Lai A, Nghiemphu P, Cloughesy T.
Department of Neurology, University of California, UCLA Department of Neurology, Neuro-Oncology Program, 710 Westwood Plaza 1-230, Los Angeles, CA 90024, USA.

Bevacizumab is a monoclonal antibody that binds and neutralizes VEGF. Bevacizumab is currently indicated as monotherapy for recurrent glioblastoma. Recent data from Phase II trials of bevacizumab as first-line therapy for glioblastoma have been promising, and have led to two Phase III trials evaluating the use of bevacizumab as first-line therapy when combined with radiation and temozolomide. Potential complications relating to interpretation of the results of these Phase III studies include the crossover use of bevacizumab upon recurrence in the placebo arm. Recently published single-arm evaluations of adding bevacizumab to standard first-line therapy in glioblastoma multiforme have shown an improvement in progression-free survival and overall survival when compared with historical controls obtained prior to widespread use of bevacizumab in recurrent glioblastoma multiforme. When these data are compared with more contemporary studies from the bevacizumab era, the improvement in progression-free survival seems to be maintained but the impact on overall survival with first-line bevacizumab therapy seems less clear. Bevacizumab therapy alters the imaging characteristics of glioblastoma, and new criteria have been established to assess treatment response and progression in the setting of widespread bevacizumab use.

PMID: 22894667 [PubMed - in process]


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