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First-line bevacizumab contributes to survival improvement in glioblastoma patients complementary to temozolomide.

Al's Comment:

This reports a pretty big improvement in overall survival when using Avastin with Temodar as first line therapy.   There are other reports that there is no survival benefit. It is hard to prove one way or the other if Avastin (or any new treatment really) has a survival benefit.  The trials that said there was no (or small)  benefit to overall survival did show a benefit in progression free survival and they were larger and randomized - which is usually more trusted, but all of these studies had other problems such as most patients had other treatments that could confound the results.   In the randomized trial, many patients in the control group crossed over to using Avastin after progression, or had more surgery or more radiation.  Too many variables.  The only way to really tell is to follow all patients in a registry so we have large numbers of patients and analyze the effects of each subsequent or concurrent therapy!


Posted on: 02/12/2020

J Neurooncol. 2020 Feb;146(3):451-458. doi: 10.1007/s11060-019-03339-0. Epub 2020 Feb 4.

First-line bevacizumab contributes to survival improvement in glioblastoma patients complementary to temozolomide.

Hata N1, Mizoguchi M2, Kuga D2, Hatae R2, Akagi Y2, Sangatsuda Y2, Amemiya T2, Michiwaki Y2, Fujioka Y2, Takigawa K2, Suzuki SO3, Yoshitake T4, Togao O4, Hiwatashi A4, Yoshimoto K2,5, Iihara K2.
 
Author information:
1. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. hatanobu@ns.med.kyushu-u.ac.jp.
2. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
3. Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
4. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
5. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Abstract
INTRODUCTION:
 
First-line bevacizumab (BEV) is now available as a treatment option for glioblastoma patients with severe clinical conditions in Japan. However, the survival benefits remain controversial. To elucidate these potential survival benefits, we retrospectively analyzed survival in glioblastoma patients receiving BEV.
METHODS:
 
We analyzed survival in 120 patients with IDH-wild type glioblastoma treated from 2002 to 2018. Overall survival (OS) was assessed in three treatment era subgroups [pre-temozolomide (TMZ), TMZ, and TMZ-BEV], and the correlations of prognostic factors with survival were evaluated.
RESULTS:
 
An improvement in survival was observed after BEV approval (median OS in the pre-TMZ, TMZ, and TMZ-BEV eras: 14.6, 14.9, and 22.1 months, respectively). A Cox proportional hazards model identified extent of resection and MGMT methylation status as significant prognostic factors in the TMZ era; however, these factors were not significant in the TMZ-BEV era. In subgroup analyses, patients with MGMT methylation had improved OS after TMZ introduction (pre-TMZ vs. TMZ, 18.5 vs. 28.1 months; P = 0.13), and those without MGMT methylation had significantly increased OS after BEV approval (TMZ vs. TMZ-BEV, 12.2 vs. 16.7 months; P = 0.04).
CONCLUSIONS:
 
Our findings imply that optional first-line administration of BEV can overcome the impact of conventional risk factors and prolong survival complementary to TMZ. The patient subgroups benefitting from TMZ and BEV did not seem to overlap, and stratification based on risk factors, including MGMT methylation status, might be effective for selecting patients in whom BEV should be preferentially used as a first-line therapy.
PMID: 32020475
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