Background Glioblastoma multiforme (GBM) are primary brain tumours that are currently incurable. Despite a well codified first-line treatment with concomitant radio-chemotherapy (temozolomide), recurrences of GBM occur and have limited treatment options. Furthermore, there is a lack of effective therapies and no standard relapse treatment. Anti-angiogenic drugs, such as bevacizumab, show encouraging results for patients with recurrences of high-grade gliomas.
Purpose To describe treatments of GBM relapses within three cities in northeast France: Nancy, Reims and Strasbourg. We especially tried to assess the impact of bevacizumab on survival endpoints.
Materials and Methods This is a retrospective study with GBM patients diagnosed between 2006 and 2008. Medical data describing the population and therapeutic oncology support were collected in each site from individual patient charts. Overall Survival (OS) and Progression Free Survival (PFS) were estimated by the Kaplan-Meier method and compared by the log-rank test.
Results Between 2006 and 2008, 321 patients were diagnosed with GBM, of whom 133 patients were treated for at least one recurrence. There were 95 males and 38 females; median age at diagnosis was 58. Main relevant signs of the initial tumour were intracranial hypertension and epilepsy. Initial treatment consisted for 64% of patients in surgical excision, and 86% of patients received conventional radio-chemotherapy followed by adjuvant temozolomide.
More than 50% of recurrences were diagnosed on both clinical and radiological grounds. Discarding palliative care, almost all patients with GBM relapse received chemotherapy: 95% at first recurrence (n = 126/133), 95% at second recurrence (n = 69/73) and 100% at third recurrence (n = 26/26). Bevacizumab was used (alone or in association) in a third to half of cases.
In our population, neglecting the type of relapse treatment, median OS was 17.8 months [5–50 months]. When patients received bevacizumab at some point in their care, median OS was 20.2 months [7–50 months]. This OS is significantly different from the median OS observed without bevacizumab which was 13.5 months [5–41 months]. PFS until the second recurrence with bevacizumab was 5.5 months compared to 3.1 months without bevacizumab. PFS until the third recurrence with bevacizumab was 5 months against 2 months without bevacizumab. However, these results do not show bevacizumab providing significant PFS improvement, especially in the long term.
Conclusions Bevacizumab seems to improve OS in patients with GBM recurrences. However only prospective randomised studies will define the appropriate strategy treatment in recurrent glioblastoma. This work is one of the several projects of the NENO group which aims to standardise practise and build rational standards.
No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.