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Advantages and disadvantages of combined chemotherapy with carmustine wafer and bevacizumab in patients with newly diagnosed glioblastoma: A single institutional experience.

Al's Comment:

 This is a small study - so it can't be relied on completely. However, it shows that adding both Gliadel and Avastin to the standard Temodar for newly diagnosed GBM added 9 months to average survival and doubled progression free survival. Another tidbit - more than half of patients operated on in this hospital in Japan received Gliadel wafer.  


Posted on: 02/28/2018

World Neurosurg. 2018 Feb 21. pii: S1878-8750(18)30341-3. doi: 10.1016/j.wneu.2018.02.070. [Epub ahead of print]
Advantages and disadvantages of combined chemotherapy with carmustine wafer and bevacizumab in patients with newly diagnosed glioblastoma: A single institutional experience.
Akiyama Y1, Kimura Y1, Enatsu R1, Mikami T1, Wanibuchi M1, Mikuni N2.
 
Author information:
 
1
    Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
2
    Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan. Electronic address: mikunin@sapmed.ac.jp.
 
Abstract
OBJECTIVE:
 
To retrospectively determine the safety and efficacy of combined chemotherapy with carmustine (BCNU) wafer, bevacizumab, and temozolomide plus radiotherapy in patients with newly diagnosed glioblastoma (GBM).
METHODS:
 
A total of 54 consecutive newly diagnosed GBMs were resected at our institution between 2010 and 2016. Twenty-nine patients underwent BCNU wafer implantation into the resection cavity followed by standard radiochemotherapy with with temozolomide (TMZ, Stupp regimen) plus additional bevacizumab treatment between 2013 and 2016. Twenty-five patients that underwent resection without BCNU implantation between 2010 and 2012 were enrolled as a control group; these patients were treated with the Stupp regimen and did not receive bevacizumab. This retrospective study included evaluation of progression-free survival (PFS) and overall survival (OS), plus comparisons between the combined therapy group and the control group.
RESULTS:
 
There were no significant differences in age, sex, Karnofsky performance status on admission, isocitrate dehydrogenase (IDH)-1/2 mutation ratio, or resection rate between the combined and standard therapy groups. The median OS in the combined therapy group and control group was 24.2 months and 15.30 respectively (p=0.027). The median PFS was 16.8 months and 7.30 months, respectively (p=0.009).Overall, the incidence of adverse events leading to discontinuation of the study drug were similar between the treatment groups, except for infection that was more common in the combined treatment group and required repeat surgery.
CONCLUSIONS:
 
The combined therapy showed higher efficacy compared with standard therapy in patients with GBM. Therefore, combined therapy seems to be effective with an acceptable toxicity profile.
 
Copyright © 2018. Published by Elsevier Inc.

 


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