Article,
The earlier the better? Bevacizumab in the treatment of recurrent MGMT-non-methylated glioblastoma
J Cancer Res Clin Oncol, 142 (8): 1825-1829 (August 2016)
DOI: 10.1007/s00432-016-2187-3
Abstract
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.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).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).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.
