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The earlier the better? Bevacizumab in the treatment of recurrent MGMT-non-methylated glioblastoma.

Al's Comment:

 These are puzzling results.  Avastin increased the time to progression by over 100% compared to chemotherapy, but the overall survival time was about 30% less. This doesn't make sense.  This brings up the question of quality vs quantity of life. Patients did well for twice as long using Avastin, but died sooner. What is worth more?  I would like to find out why the people in the Avastin group didn't live as long as those in the chemotherapy group.  I wonder if the chemotherapy group used Avastin after recurrence?


Posted on: 06/29/2016

2. J Cancer Res Clin Oncol. 2016 Jun 18. [Epub ahead of print]
The earlier the better? Bevacizumab in the treatment of recurrent MGMT-non-methylated glioblastoma.
Schaub C1, Schäfer N1,2, Mack F1, Stuplich M1, Kebir S1,2, Niessen M1, Tzaridis T1, Banat M3, Vatter H3, Waha A4, Herrlinger U1, Glas M5,6,7.
 
Author information:
1Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
2Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
3Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
4Department of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
5Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. martin.glas@ukb.uni-bonn.de.
6Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. martin.glas@ukb.uni-bonn.de.
7Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Germany. martin.glas@ukb.uni-bonn.de.
 
Abstract
PURPOSE:
 
The adequate second-line therapy of patients with glioblastoma (GBM) is a matter of ongoing debate. This particularly applies to patients with a non-methylated MGMT promotor who are known to have a poor response to alkylating chemotherapy. In some countries, antiangiogenic therapy with BEV is applied as second-line therapy, and in others nitrosourea therapy is second-line choice. It is an open question whether the delay of BEV to third-line therapy has a negative impact on survival.
METHODS:
 
A total of 61 adult patients (median age 56.9 years) with MGMT-non-methylated relapsed GBM treated with BEV (n = 45) or nitrosourea (n = 16) as second-line therapy were analyzed retrospectively and compared regarding progression-free survival (PFS) and overall survival (OS).
RESULTS:
 
Patients treated with second-line BEV had longer median PFS (107 days, 95 % CI 80.7-133.2 days) than patients with second-line nitrosourea (52 days, 95 % CI 36.3-67.7 days, P = 0.011, logrank test). However, there was no significant difference in overall survival (BEV median 170 days, 95 % CI 87.2-252.8 days; nitrosourea median 256 days, 95 % CI 159.9-352.0 days, P = 0.468). PFS was similar after BEV third-line therapy (median 117 days, 95 % CI 23.6-210.4 days) as compared to second-line BEV therapy (median 107 days, 95 % CI 80.7-133.3 days, P = 0.584).
CONCLUSION:
 
Our findings suggest that early treatment with BEV in patients with MGMT-non-methylated relapsed GBM is associated with a better PFS, but not with superior OS, possibly implicating that the early, i.e., second-line, use of BEV is not mandatory and BEV treatment may safely be delayed to third-line therapy in this subgroup of patients.

 


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