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- Title
Bevacizumab in Recurrent Glioblastoma: Efficacy Benchmarks and Safety in Different Doses, Combinations, Time and Situations.
- Authors
Gil-Gil, Miguel J.; Barroso, Carles Mesía; Escuer, Jordi Bruna
- Abstract
Glioblastoma or grade IV glioma is the most common primary brain tumor in adults. With standard treatment, median overall survival is only 14-15 months and less than 10% of patients will survive five years after diagnosis. There is no standard treatment in recurrent glioblastoma and overall survival ranges from three to nine months. Glioblastoma is one of the most vascularized human tumors and glioblastoma cells produce vascular endothelial growth factor. Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, has demonstrated activity in vitro and in phase II trials in relapse, as well as in two phase III trials as first-line therapy. Bevacizumab also improves quality of life for patients suffering from glioblastoma. Toxicity is acceptable, and the most serious adverse events, defined as grade 3 or 4, are 9% or less. Bevacizumab has improved progression-free survival, objective response rate, and, it seems, overall survival relative to historic salvage therapy in recurrent glioblastoma. There is no proof that high doses of bevacizumab (10 mg/kg every two weeks) are better than low doses (5 mg/kg every two weeks). Only a phase II randomized study has shown better results with the combination of bevacizumab plus lomustine compared to using either individually. Other combinations of bevacizumab with chemotherapy have not shown better results than bevacizumab alone. Bevacizumab has demonstrated responses at any time in the progression and initiating bevacizumab in first, second or third progression has not been shown to have a negative effect on overall survival. For its anti-edema effect, it may be particularly suited for use in patients with unresectable bulky tumors. Now, a phase III double-blind study is open that will answer the question of whether after progression with bevacizumab, treatment should continue with bevacizumab associated with another cytostatic. However, there is a lack of phase III studies to provide definitive answers on the true impact in overall survival of bevacizumab in recurrent glioblastoma.
- Subjects
BEVACIZUMAB; GLIOBLASTOMA multiforme treatment; DRUG dosage; VASCULAR endothelial growth factors; DRUG side effects; DRUG toxicity
- Publication
Cancer & Chemotherapy Reviews, 2014, Vol 9, Issue 2, p51
- ISSN
1885-740X
- Publication type
Article