Journal of Neuro-Oncology

, Volume 137, Issue 2, pp 439–446 | Cite as

Toxicity and efficacy of lomustine and bevacizumab in recurrent glioblastoma patients

  • J. N. JakobsenEmail author
  • T. Urup
  • K. Grunnet
  • A. Toft
  • M. D. Johansen
  • S. H. Poulsen
  • I. J. Christensen
  • A. Muhic
  • H. S. Poulsen
Clinical Study


The combination of lomustine and bevacizumab is a commonly used salvage treatment for recurrent glioblastoma (GBM). We investigated the toxicity and efficacy of lomustine plus bevacizumab (lom-bev) in a community-based patient cohort and made a comparison to another frequently used combination therapy consisting of irinotecan plus bevacizumab (iri-bev). Seventy patients with recurrent GBM were treated with lomustine 90 mg/m2 every 6 weeks and bevacizumab 10 mg/kg every 2 weeks. Toxicity was registered and compared to the toxicity observed in 219 recurrent GBM patients who had previously been treated with irinotecan 125 mg/m2 and bevacizumab 10 mg/kg every 2 weeks. The response rate was 37.1% for lom-bev and 30.1% for iri-bev. Median progression-free survival (PFS) was 23 weeks for lom-bev and 21 weeks for iri-bev (p = 0.9). Overall survival (OS) was 37 weeks for lom-bev and 32 weeks for iri-bev (p = 0.5). Lom-bev caused a significantly higher frequency of thrombocytopenia (11.4% grade 3–4) compared to iri-bev (3.5% grade 3–4). Iri-bev patients had more gastrointestinal toxicity with regard to nausea, vomiting, diarrhea, constipation and stomatitis. Within the limitations of the study lom-bev is a well-tolerated treatment for recurrent GBM, although hematological toxicity may be a dose limiting factor. No significant differences between lom-bev and iri-bev were observed with regard to PFS or OS. The differences in toxicity profiles between lom-bev and iri-bev could guide treatment decision in recurrent GBM therapy as efficacy is equal and no predictive factors for efficacy exist.


Glioblastoma Bevacizumab Irinotecan Lonustine Chemotherapy Recurrent glioblastoma 


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Ethical approval

This study was performed according to the Declaration of Helsinki and Danish legislation and permissions was given from the Danish Data Protection Agency (2015-41-4118).

Informed consent

All patients gave informed consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • J. N. Jakobsen
    • 1
    Email author
  • T. Urup
    • 1
  • K. Grunnet
    • 2
  • A. Toft
    • 2
  • M. D. Johansen
    • 2
  • S. H. Poulsen
    • 1
    • 2
  • I. J. Christensen
    • 3
  • A. Muhic
    • 1
  • H. S. Poulsen
    • 2
  1. 1.Department of OncologyRigshospitaletCopenhagenDenmark
  2. 2.Department of Radiation BiologyRigshospitaletCopenhagenDenmark
  3. 3.Department of Surgical GastroenterologyHvidovre HospitalHvidovreDenmark

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