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Add-on bevacizumab can prevent early clinical deterioration and prolong survival in newly diagnosed partially resected glioblastoma patients with a poor performance status

Authors Hata N, Yoshimoto K, Hatae R, Kuga D, Akagi Y, Sangatsuda Y, Suzuki SO, Shono T, Mizoguchi M, Iihara K

Received 24 October 2016

Accepted for publication 7 December 2016

Published 18 January 2017 Volume 2017:10 Pages 429—437


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Manfred Beleut

Peer reviewer comments 2

Editor who approved publication: Dr Carlos E Vigil

Nobuhiro Hata,1,2 Koji Yoshimoto,1 Ryusuke Hatae,1 Daisuke Kuga,1 Yojiro Akagi,1 Yuhei Sangatsuda,1 Satoshi O Suzuki,3 Tadahisa Shono,1,4 Masahiro Mizoguchi,1,5 Koji Iihara1

1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 2Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 3Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, 4Department of Neurosurgery, Harasanshin Hospital, Fukuoka, 5Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

Purpose: The AVAglio trial established the beneficial effect of add-on bevacizumab (BEV) for the treatment of newly diagnosed glioblastomas (nd-GBMs) that led to the approval of BEV for the treatment of these patients in Japan. However, the rationality of using BEV as a first-line treatment for nd-GBMs remains controversial. The purpose of this study was to analyze the outcomes of a case series of nd-GBM patients.
Patients and methods: The outcomes of 69 nd-GBM patients treated after 2006 were retrospectively analyzed. Clinical and genetic analyses were performed, and estimates of progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Since add-on BEV therapy was only used for partially resected GBMs (pr-GBMs) after its approval in 2013, the patients were subdivided into 3 treatment groups: Type I, partial removal with temozolomide (TMZ)/BEV and concurrent radiotherapy (CCRT); Type II, partial removal with TMZ and CCRT; and Type III, gross total removal with TMZ and CCRT.
Results: The PFS rate of Type I patients was significantly higher than that of Type II patients (P=0.014), but comparable to that of Type III patients. Differences in OS rates between Type I and Type II patients were less apparent (P=0.075), although the median OS of Type I patients was ~8 months higher than that of Type II patients (17.4 vs 9.8 months, respectively). The clinical deterioration rate during initial treatment was significantly (P=0.024) lower in Type I than in Type II patients (7.7% vs 47.4%, respectively). Differences in OS rates between Type I and Type II patients with a poor performance status (PS) were significant (P=0.017).
Conclusion: Our findings suggest that add-on BEV can prevent early clinical deterioration of pr-GBM patients and contribute to a prolonged survival, especially for those with a poor PS.

Keywords: bevacizumab, glioblastoma, performance status, survival, unresectable

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