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Prognostic factors in recurrent glioblastoma patients treated with bevacizumab

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Abstract

The value of bevacizumab (BEV) in recurrent glioblastoma is unclear. Imaging parameters and progression-free survival (PFS) are problematic endpoints. Few data exist on clinical factors influencing overall survival (OS) in unselected patients with recurrent glioblastoma exposed to BEV. We retrospectively analyzed 174 patients with recurrent glioblastoma treated with BEV at two German brain tumor centers. We evaluated general patient characteristics, MGMT status, pretreatment, concomitant oncologic treatment and overall survival. Karnofsky performance score, number of prior chemotherapies, number of prior recurrences and combined treatment with irinotecan (IRI) were significantly associated with OS in univariate analysis. We did not find differences in OS related to sex, age, histology, MGMT status, prior surgical treatment or number of prior radiotherapies. Combined treatment with IRI and higher KPS both remained significantly associated with prolonged survival in multivariate analysis, but patients receiving IRI co-treatment had less advanced disease. Grouping into clinically relevant categories revealed an OS of 16.9 months from start of BEV in patients with first recurrence and KPS ≥ 80 % (n = 25). In contrast, in patients with second recurrence and KPS < 80 %, OS was 3.6 months (n = 27). Our observational data support an early use of BEV in patients with good performance status. The benefit of co-treatment with IRI in our cohort seems to be the result of biased patient recruitment.

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Acknowledgments

The Dr. Senckenberg Institute of Neurooncology is supported by the Dr. Senckenberg Foundation and the Hertie Foundation. J.P.S. is “Hertie Professor of Neurooncology”.

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    Authors and Affiliations

    1. Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany

      Christina Schaub, Niklas Schäfer, Frederic Mack, Sied Kebir, Ulrich Herrlinger & Martin Glas

    2. Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany

      Julia Tichy, Anna-Luisa Thiepold, Joachim P. Steinbach, Johannes Rieger & Oliver Bähr

    3. Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Bonn, Germany

      Niklas Schäfer, Sied Kebir & Martin Glas

    4. Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany

      Kea Franz

    5. Institute of Neurology (Edinger-Institute), Goethe University Hospital, Frankfurt, Germany

      Michel Mittelbronn

    6. Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany

      Andreas Waha

    7. Institute of Biostatistics and Mathematical Modeling, Goethe University Hospital Frankfurt, Frankfurt, Germany

      Natalie Filmann

    8. Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany

      Mohammed Banat

    9. Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn Medical Center, Bonn, Germany

      Rolf Fimmers

    10. Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, Bonn, Germany

      Martin Glas

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    1. Christina Schaub
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    Correspondence to Martin Glas or Oliver Bähr.

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    Conflict of Interest

    Joachim P. Steinbach has served as a consultant for Roche the European distributer of Bevacizumab. Ulrich Herrlinger has served as a consultant for Roche. He has also received scientific grants and speakers honoraria from Roche. Johannes Rieger has served as a consultant for Roche. Martin Glas has served as a consultant for Roche and has received speakers honoraria form Roche. Oliver Bähr has served as a consultant for Roche and has received travel grants from Roche. Niklas Schäfer received honoraria from Roche. All other authors declare that they have no conflict of interest.

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    Christina Schaub and Julia Tichy have contributed equally to this work.

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    Schaub, C., Tichy, J., Schäfer, N. et al. Prognostic factors in recurrent glioblastoma patients treated with bevacizumab. J Neurooncol 129, 93–100 (2016). https://doi.org/10.1007/s11060-016-2144-7

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