Hostname: page-component-89b8bd64d-r6c6k Total loading time: 0 Render date: 2026-05-11T06:51:17.307Z Has data issue: false hasContentIssue false
  • English
  • Français

Bevacizumab Use for Recurrent High-Grade Glioma at McGill University Hospital

Published online by Cambridge University Press:  23 September 2014

Solmaz Sahebjam ,
Evgenia Garoufalis ,
Marie-Christine Guiot ,
Thierry Muanza ,
Rolando Del Maestro ,
Kevin Petrecca ,
Rajesh Sharma  and
Petr Kavan
Solmaz Sahebjam
Affiliation:
Drug Development Program, Princess Margaret Hospital, Toronto, Ontario
Evgenia Garoufalis
Affiliation:
Department of Oncology, McGill University, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada
Marie-Christine Guiot
Affiliation:
Department of Pathology, McGill University, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada
Thierry Muanza
Affiliation:
Division of Radiation Oncology, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada
Rolando Del Maestro
Affiliation:
Department of Oncology and Segal Cancer Centre, McGill University, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec; Canada
Kevin Petrecca
Affiliation:
Department of Oncology and Segal Cancer Centre, McGill University, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec; Canada
Rajesh Sharma
Affiliation:
Department of Oncology, McGill University, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada
Petr Kavan*
Affiliation:
Department of Oncology, McGill University, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec Canada
*
McGill University, Royal Victoria Hospital, Department of Oncology, 687 Pine avenue West, Montreal, Quebec, H3a 1a1, Canada. Email: petr.kavan@mcgill.ca.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.
Background:

Bevacizumab, a humanized recombinant anti-vascular endothelial growth factor antibody, was approved in Canada in 2010 for the treatment of high-grade glioma. We report the effectiveness and safety of bevacizumab in the treatment of patients with recurrent high-grade gliomas at a single institution.

Methods:

Twenty-seven consecutive patients with high-grade glioma (anaplastic glioma and glioblastoma) at first or subsequent relapse were treated with bevacizumab alone or in combination with chemotherapy. The primary endpoint was progression-free survival (PFS) and secondary endpoints were objective response rate, six month PFS, overall survival (OS), and safety profile.

Results:

The clinical benefit rate (complete and partial responses plus stable disease) was 59%. Median PFS was 4.3 (95% CI, 3.0-10.9) months, with a six month PFS rate of 43%. Median OS after current relapse was 8.9 (95% CI, 5.8-not reached) months. Ten episodes of grade 3/4 adverse events were observed in nine patients, including fatigue (n = 3), thrombocytopenia (n = 4), and myelotoxicity, febrile neutropenia, and pulmonary embolism (each n = 1).

Conclusions:

We consider the efficacy and safety profile of bevacizumab is comparable to other cohorts of patients treated for recurrent high-grade glioma at other international institutions.

Résumé:

Résumé: Contexte:

Le bevacizumab, un anticorps recombinant humanisé dirigé contre le facteur de croissance endothélial vasculaire, a été approuvé au Canada en 2010 pour le traitement du gliome de haut grade de malignité. Nous rapportons l'efficacité et la sécurité du bevacizumab dans le traitement de patients présentant une récidive de gliomes de haut grade de malignité dans notre institution.

Méthode:

Vingt-sept patients consécutifs atteints de gliomes de haut grade de malignité (gliomes anaplasiques et glioblastomes) ont été traités par le bevacizumab seul ou en combinaison à la chimiothérapie à la première récidive ou au moment de récidives subséquentes. le critère d'évaluation primaire était la survie sans progression (SSP) et les critères d'évaluation secondaires étaient le taux de réponse objective, une SSP de 6 mois, la survie globale (SG), et le profil de sécurité.

Résultats:

Le taux de bénéfice clinique (réponse complète et partielle avec maladie stable) était de 59%. la SSP médiane était de 4,3 mois (IC à 95%: 3,0 à 10,9) avec un taux de SSP de 6 mois de 43%. la SG médiane après la récidive en cours était de 8,9 mois (IC à 95% de 5,8 à non atteinte). Dix épisodes d'incidents thérapeutiques de grade ¾ ont été observés chez 9 patients, dont de la fatigue (n = 3), une thrombocytopénie (n = 4) et une myélotoxicité, une neutropénie fébrile et une embolie pulmonaire (n = 1 chacun).

Conclusions:

Nous considérons que le profil d'efficacité et de sécurité du bevacizumab que nous avons observé est comparable à celui d'autres cohortes de patients traités pour une récidive d'un gliome de haut grade de malignité dans d'autres institutions internationales.

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 2 , March 2013 , pp. 241 - 246
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. Adamson, C, Kanu, OO, Mehta, AI, et al. Glioblastoma multiforme: a review of where we have been and where we are going. Expert Opin Investig Drugs. 2009;18(8):1061–83.Google Scholar
2. Stupp, R, Mason, WP, van den Bent, MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.Google Scholar
3. Curran, WJ Jr, Scott, CB, Horton, J, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993;85(9):704–10.Google Scholar
4. Kargiotis, O, Rao, JS, Kyritsis, AP. Mechanisms of angiogenesis in gliomas. J Neurooncol. 2006;78(3):281–93.CrossRefGoogle ScholarPubMed
5. Ferrara, N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev. 2004;25(4):581–611.CrossRefGoogle ScholarPubMed
6. Hicklin, DJ, Ellis, LM. Role of the vascular endothelial growth factor pathway in tumor growth and angiogenesis. J Clin Oncol. 2005;23(5):1011–127.CrossRefGoogle ScholarPubMed
7. Gerber, HP, Ferrara, N. Pharmacology and pharmacodynamics of bevacizumab as monotherapy or in combination with cytotoxic therapy in preclinical studies. Cancer Res. 2005;65(3):671–80.CrossRefGoogle ScholarPubMed
8. Yang, JC, Haworth, L, Sherry, RM, et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003;349(5):427–34.CrossRefGoogle ScholarPubMed
9. Hurwitz, H, Fehrenbacher, L, Novotny, W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335–42.Google Scholar
10. Sandler, A, Gray, R, Perry, MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355(24):2542–50.Google Scholar
11. Miller, K, Wang, M, Gralow, J, et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med. 2007;357(26):2666–76.CrossRefGoogle ScholarPubMed
12. Mathieu, V, De Néve, N, Le Mercier, M, et al. Combining bevacizumab with temozolomide increases the antitumor efficacy of temozolomide in a human glioblastoma orthotopic xenograft model. Neoplasia. 2008;10(12):1383–92.Google Scholar
13. Lee, CG, Heijn, M, di Tomaso, E, et al. Anti-vascular endothelial growth factor treatment augments tumour radiation response under normoxic or hypoxic conditions. Cancer Res. 2000;60(19):5565–70.Google Scholar
14. Vredenburgh, JJ, Desjardins, A, Herndon, JE 2nd, et al: Phase II trial of bevacizumab and irinotecan in recurrent malignant glioma. Clin Cancer Res. 2007a;13(4):1253–9.Google Scholar
15. Vredenburgh, JJ, Desjardins, A, Herndon, JE 2nd, et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol. 2007b;25(30):4722–9.CrossRefGoogle ScholarPubMed
16. Norden, AD, Young, GS, Setayesh, K, et al. Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence. Neurology. 2008;70(10):779–87.Google Scholar
17. Kreisl, TN, Kim, L, Moore, K, et al. Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol. 2009;27(5):740–5.Google Scholar
18. Friedman, HS, Prados, MD, Wen, PY, et al. Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol. 2009;27(28):4733–40.Google Scholar
19. Cohen, MH, Shen, YL, Keegan, P, Pazdur, R. FDA drug approval summary: bevacizumab (Avastin) as treatment of recurrent glioblastoma multiforme. Oncologist. 2009;14(11):1131–8.Google Scholar
20. Wen, PY, Macdonald, DR, Reardon, DA, et al. Updated response assessment criteria for high-grade gliomas: Response assessment in neuro-oncology working group. J Clin Oncol. 2010;28(11):1963–72.Google Scholar
21. Theeler, BJ, Groves, MD. High-grade gliomas. Curr Treat Options Neurol. 2011;13(4):386–99.CrossRefGoogle ScholarPubMed
22. Yung, WK, Albright, RE, Olson, J, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer. 2000;83(5):588–93.Google Scholar
23. Wong, ET, Gautam, S, Malchow, C, Lun, M, Pan, E, Brem, S. Bevacizumab for recurrent glioblastoma multiforme: a meta-analysis. J Natl Compr Canc Netw. 2011;9(4):403–7.CrossRefGoogle ScholarPubMed
24. Poulsen, HS, Grunnet, K, Sorensen, M, et al. Bevacizumab plus irinotecan in the treatment patients with progressive recurrent malignant brain tumours. Acta Oncol. 2009;48(1):52–8.CrossRefGoogle ScholarPubMed
25. Soffietti, R, Ruda, R, Trevisan, E, et al. Phase II study of bevacizumab and nitrosourea in patients with recurrent malignant glioma: a multicenter Italian study. J Clin Oncol. 2009;27(suppl; abstr 2012).Google Scholar
26. Reardon, DA, Desjardins, A, Vredenburgh, JJ, et al. Metronomic chemotherapy with daily, oral etoposide plus bevacizumab for recurrent malignant glioma: a phase II study. Br J Cancer. 2009;101(12):1986–94.Google Scholar
27. Guiu, S, Taillibert, S, Chinot, O, et al. Bevacizumab/irinotecan. An active treatment for recurrent high grade gliomas: preliminary results of an ANOCEF Multicenter Study. Rev Neurol (Paris). 2008;164(6-7):588–94.Google Scholar
28. Gilbert, MR, Wang, M, Aldape, K, et al. RTOG 0625: a phase II study of bevacizumab with irinotecan in recurrent glioblastoma (GBM). J Clin Oncol. 2009;27(suppl; abstr 2011).Google Scholar
29. Sathornsumetee, S, Desjardins, A, Vredenburgh, JJ, et al. Phase II trial of bevacizumab and erlotinib in patients with recurrent malignant glioma. Neuro Oncol. 2010;12(12):1300–10.Google Scholar
30. Verhoeff, JJ, Lavini, C, van Linde, ME, et al. Bevacizumab and dose-intense temozolomide in recurrent high-grade glioma. Ann Oncol. 2010;21(8):1723–7.Google Scholar
31. Elandt, K, Preusser, M, Hassler, M, et al. Treatment with bevacizumab and liposomal doxorubicin for recurrent high-grade gliomas (HGGs). J Clin Oncol. 2010;28(suppl; abstr e12522).Google Scholar
32. Calabrich, A, Azevedo, FC, Saad, ED, et al. The feasibility and real-life effectiveness of the combination of chemotherapy (CT) and bevacizumab (Bev) in the treatment of high-grade gliomas (HGG) in a private community oncology center. J Clin Oncol. 2010;28(suppl; abstr e12552).CrossRefGoogle Scholar
33. Gallardo Martin, E, Areses Manrique, MC, Anido Herranz, U, et al. Efficacy, toxicity, and pattern of response and progression in patients with high-grade gliomas treated with bevacizumab and irinotecan: experience in one center. J Clin Oncol. 2010;28 (suppl; abstr e12553).Google Scholar
34. Vredenburgh, JJ, Coughesy, T, Samant, M, et al. Corticosteroid use in patients with glioblastoma at first or second relapse treated with bevacizumab in the BRAIN study. Oncologist. 2010;15(12):1329–34.CrossRefGoogle ScholarPubMed
35. Henriksson, R, Asklund, T, Poulsen, HS. Impact of therapy on quality of life, neurocognitive function and their correlates in glioblastoma multiforme: a review. J Neurooncol. 2011;104(3):639–46.Google Scholar