Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature
Background: Despite multidisciplinary treatment approaches, the prognosis for patients with high-grade glioma (HGG) is poor, with a median overall survival (OS) of 14.6 months for glioblastoma multiforme (GB). As high levels of vascular endothelial growth factor A (VEGF) are found in HGG, targeted a...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2018-01-01
|
| Series: | Therapeutic Advances in Neurological Disorders |
| Online Access: | https://doi.org/10.1177/1756285617753597 |
| _version_ | 1818134527339397120 |
|---|---|
| author | Jennifer Jeck Rebecca Kassubek Jan Coburger Simone Edenhofer Stefan S. Schönsteiner Albert C. Ludolph Bernd Schmitz Jens Engelke Regine Mayer-Steinacker Jan Lewerenz Lars Bullinger |
| author_facet | Jennifer Jeck Rebecca Kassubek Jan Coburger Simone Edenhofer Stefan S. Schönsteiner Albert C. Ludolph Bernd Schmitz Jens Engelke Regine Mayer-Steinacker Jan Lewerenz Lars Bullinger |
| author_sort | Jennifer Jeck |
| collection | DOAJ |
| description | Background: Despite multidisciplinary treatment approaches, the prognosis for patients with high-grade glioma (HGG) is poor, with a median overall survival (OS) of 14.6 months for glioblastoma multiforme (GB). As high levels of vascular endothelial growth factor A (VEGF) are found in HGG, targeted anti-antiangiogenic therapy using the humanized monoclonal antibody bevacizumab (BEV) was studied in a series of clinical trials. Still, the discrepancy of BEV’s efficacy with regard to initial clinical and radiological response and its reported failure to prolong survival remains to be explained. Here, we illustrate the effectiveness of BEV in recurrent HGG by summarizing our single-centre experience. Methods: We have retrospectively investigated the effect of BEV in temozolomide refractory HGG in 39 patients treated at the University Hospital of Ulm, Germany. Results: Median duration of BEV treatment was 12.5 weeks; 23% of patients received BEV for more than 6 months and 15% for more than 1 year, until clinical or radiological tumour progression led to discontinuation. Furthermore, Karnofsky performance status increased in 30.6% and steroid dose decreased in 39% of all patients. Conclusions: The review of literature reveals that phase II and III studies support BEV as an effective therapy in recurrent HGG, at least with regard to progression-free survival (PFS), but landmark phase III trials failed to prove benefit concerning OS. Here, we discuss reasons that may account for this observation. We conclude that prolonging PFS with maintenance of neurological function and personal and economic independency justifies the off-label use of BEV. |
| first_indexed | 2024-12-11T09:10:02Z |
| format | Article |
| id | doaj.art-57e1c1e0ded047f79bd6a78df4953e55 |
| institution | Directory Open Access Journal |
| issn | 1756-2864 |
| language | English |
| last_indexed | 2024-12-11T09:10:02Z |
| publishDate | 2018-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Neurological Disorders |
| spelling | doaj.art-57e1c1e0ded047f79bd6a78df4953e552022-12-22T01:13:32ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642018-01-011110.1177/1756285617753597Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literatureJennifer JeckRebecca KassubekJan CoburgerSimone EdenhoferStefan S. SchönsteinerAlbert C. LudolphBernd SchmitzJens EngelkeRegine Mayer-SteinackerJan LewerenzLars BullingerBackground: Despite multidisciplinary treatment approaches, the prognosis for patients with high-grade glioma (HGG) is poor, with a median overall survival (OS) of 14.6 months for glioblastoma multiforme (GB). As high levels of vascular endothelial growth factor A (VEGF) are found in HGG, targeted anti-antiangiogenic therapy using the humanized monoclonal antibody bevacizumab (BEV) was studied in a series of clinical trials. Still, the discrepancy of BEV’s efficacy with regard to initial clinical and radiological response and its reported failure to prolong survival remains to be explained. Here, we illustrate the effectiveness of BEV in recurrent HGG by summarizing our single-centre experience. Methods: We have retrospectively investigated the effect of BEV in temozolomide refractory HGG in 39 patients treated at the University Hospital of Ulm, Germany. Results: Median duration of BEV treatment was 12.5 weeks; 23% of patients received BEV for more than 6 months and 15% for more than 1 year, until clinical or radiological tumour progression led to discontinuation. Furthermore, Karnofsky performance status increased in 30.6% and steroid dose decreased in 39% of all patients. Conclusions: The review of literature reveals that phase II and III studies support BEV as an effective therapy in recurrent HGG, at least with regard to progression-free survival (PFS), but landmark phase III trials failed to prove benefit concerning OS. Here, we discuss reasons that may account for this observation. We conclude that prolonging PFS with maintenance of neurological function and personal and economic independency justifies the off-label use of BEV.https://doi.org/10.1177/1756285617753597 |
| spellingShingle | Jennifer Jeck Rebecca Kassubek Jan Coburger Simone Edenhofer Stefan S. Schönsteiner Albert C. Ludolph Bernd Schmitz Jens Engelke Regine Mayer-Steinacker Jan Lewerenz Lars Bullinger Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature Therapeutic Advances in Neurological Disorders |
| title | Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature |
| title_full | Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature |
| title_fullStr | Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature |
| title_full_unstemmed | Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature |
| title_short | Bevacizumab in temozolomide refractory high-grade gliomas: single-centre experience and review of the literature |
| title_sort | bevacizumab in temozolomide refractory high grade gliomas single centre experience and review of the literature |
| url | https://doi.org/10.1177/1756285617753597 |
| work_keys_str_mv | AT jenniferjeck bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT rebeccakassubek bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT jancoburger bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT simoneedenhofer bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT stefansschonsteiner bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT albertcludolph bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT berndschmitz bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT jensengelke bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT reginemayersteinacker bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT janlewerenz bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature AT larsbullinger bevacizumabintemozolomiderefractoryhighgradegliomassinglecentreexperienceandreviewoftheliterature |