Progression-free and overall survival in patients with recurrent Glioblastoma multiforme treated with last-line bevacizumab versus bevacizumab/lomustine
Progression-free and overall survival in patients with recurrent Glioblastoma multiforme treated with last-line bevacizumab versus bevacizumab/lomustine
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DOI：
10.1007/s11060-015-2002-z
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发表时间：
2016-02-01
影响因子：
3.9
通讯作者：
Weyerbrock, A.
中科院分区：
文献类型：
--
作者：
Heiland, D. H.;Masalha, W.;Weyerbrock, A.
贝伐单抗（BEV）广泛用于治疗复发性多形性胶质母细胞瘤（GBM）患者。1-（2-氯乙基）-环己基-亚硝基脲（CCNU，洛莫司汀）单药治疗是复发性GBM的获批化疗选择。最近的证据表明BEV和CCNU联合治疗首次复发GBM的患者具有生存益处。我们研究了BEV单药治疗与BEV/CCNU治疗作为最后一线治疗时复发性GBM患者的结局。本回顾性研究纳入了2010年至2014年期间接受治疗的35例复发性GBM患者。根据BEV或BEV/CCNU治疗的开始和初始诊断确定无进展生存期和总生存期。BEV单药治疗17例，BEV+环己亚硝脲联合治疗18例。IDH突变、MGMT启动子甲基化、肿瘤定位、组织学和手术次数等参数的影响包括在多变量ANOVA分析中。观察Karnofsky评分（KPS）、神经功能评分及毒副反应。与BEV单药治疗相比，BEV/CCNU治疗导致PFS（6.11个月; 95% CL 3.41-12.98个月;对数秩p = 0.00241）和OS（6.59个月; 95% CL 5.51-16.3个月;对数秩p = 0.0238）延长2个月。这种生存优势与组织学、IDH突变状态或既往手术次数无关。两个治疗组之间的神经功能、KPS和毒性无显著差异。与BEV单药治疗相比，BEV/CCNU的最后一线治疗导致更长的PFS和OS，并且耐受性良好。这些发现证实了这些药物在治疗复发性GBM中的作用，并与其他研究一致。
Bevacizumab (BEV) is widely used for treatment of patients with recurrent glioblastoma multiforme (GBM). 1-(2-Chlorethyl)-cyclohexyl-nitrosourea (CCNU, lomustine) monotherapy is an approved chemotherapeutical option for recurrent GBM. Recent evidence demonstrated a survival benefit of combined treatment with BEV and CCNU in patients with a first recurrence of GBM. We examined the outcome of recurrent GBM patients with BEV monotherapy versus BEV/CCNU therapy when used as last-line therapy. 35 patients with recurrent GBM treated between 2010 and 2014 were included in this retrospective study. Progression-free and overall survival was determined with reference to the beginning of BEV or BEV/CCNU therapy and initial diagnosis. 17 patients received BEV monotherapy, 18 patients received combined BEV and CCNU therapy. The impact of parameters such as IDH mutation, MGMT promoter methylation, tumor localization, histology and the number of surgeries were included in a multivariate ANOVA analysis. Furthermore, Karnofsky performance score (KPS), neurological function and toxicity were assessed. BEV/CCNU treatment led to an extension of PFS (6.11 months; 95 % CL 3.41-12.98 months; log-rank p = 0.00241) and OS (6.59 months; 95 % CL 5.51-16.3 months; log-rank p = 0.0238) of 2 months compared to BEV monotherapy. This survival advantage was independent of histology, IDH mutation status or the number of previous surgeries. Neurological function, KPS and toxicity were not significantly different between both treatment groups. Last-line therapy with BEV/CCNU results in a longer PFS and OS compared to BEV monotherapy and is well-tolerated. These findings confirm the role of these agents in the treatment of recurrent GBM and are in line with other studies.