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Journal of Neurosurgical Sciences 2018 Jul 09

DOI: 10.23736/S0390-5616.18.04463-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

The prognostic improvement of add-on bevacizumab for progressive disease during concomitant temozolomide and radiation therapy in the patients with glioblastoma and anaplastic astrocytoma

Shigeru YAMAGUCHI 1, Yukitomo ISHI 1, Hiroaki MOTEGI 1, Michinari OKAMOTO 1, Hiroyuki KOBAYASHI 1 , Kenji HIRATA 2, Yoshitaka ODA 3, Shinya TANAKA 3, Shunsuke TERASAKA 1, Kiyohiro HOUKIN 1

1 Department of Neurosurgery, Faculty of Medicine, Hokkaido University, Sapporo, Japan; 2 Nuclear Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan; 3 Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan


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BACKGROUND: Although newly diagnosed high-grade glioma patients in Japan can receive bevacizumab (BEV) as first-line chemotherapy, randomized clinical trials have not shown a survival benefit for BEV for these patients. In this study, we investigated whether selective add-on BEV for patients with newly diagnosed glioblastoma (GBM) and anaplastic astrocytoma (AA) improves prognosis, in cases where tumors were continuously growing during radiotherapy concomitant with temozolomide (TMZ).
METHODS: We conducted a retrospective survey of the overall survival (OS) of patients with GBM/AAs who were treated in our institution between 2006 and 2016. Patients whose tumors were continuously growing regardless of radiotherapy were categorized as the “progressive” group; remaining patients were categorized as the “non-progressive” group. Since 2013, patients in the “progressive” group received add-on BEV therapy with the Stupp regimen during or just after radiotherapy.
RESULTS: Of 151 GBM/AA patients, 34 (22.5%) were categorized in the “progressive” group. Median OSs of the “progressive” and “non-progressive” groups were 13.2 months and 25.3 months, respectively (P < 0.001). Twelve patients in the “progressive” group received add-on BEV therapy, and their median OS was 20.2 months; whereas for the remaining 22 patients in the “progressive” group who were treated before the BEV era, their median OS was 10.5 months. In the “progressive” group, add-on BEV significantly extended OS (P = 0.018) and was the lone clinical factor of better prognosis.
CONCLUSIONS: We found that, for patients with GBM/AAs whose tumors were continuously growing during radiotherapy, add-on BEV treatment resulted in survival benefits.


KEY WORDS: Astrocytoma - Bevacizumab - Glioblastoma - Radiotherapy - Temozolomide

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