title: Patterns of progression in patients with recurrent glioblastoma treated with bevacizumab.
abstract: OBJECTIVE
  We evaluated patterns of tumor progression in patients with recurrent glioblastoma who were treated with bevacizumab (BEV) alone or in combination with irinotecan (CPT-11) while participating in the BRAIN study.
  
  
  METHODS
  An independent neuroradiologist reviewed MRI scans at baseline and progression in patients who received BEV (n = 85) or BEV+CPT-11 (n = 82) while on BRAIN. Tumor patterns were scored as local, distant, diffuse, or multifocal. Median progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. Hazard ratios for PFS and OS were estimated using a Cox regression model.
  
  
  RESULTS
  Twenty-eight percent of patients who participated in BRAIN had nonlocal disease at baseline (72% local disease). Sixty-seven (79%) patients treated with single-agent BEV and 57 (70%) patients treated with BEV+CPT-11 experienced disease progression while on BRAIN. Most patients in each treatment group did not have a change in the radiographic pattern of their tumor (i.e., "no shift") at the time of progression. The proportion of BEV patients with no shift (82%) was greater than that of BEV+CPT-11 patients (53%, χ(2) p = 0.0004), and a greater proportion of BEV+CPT-11 patients (39%) compared with BEV patients (16%) experienced local-to-diffuse tumor pattern at progression (χ(2) p = 0.002). Patients treated with BEV or BEV+CPT-11 who had local-to-local or local-to-diffuse progression patterns had similar efficacy outcomes, including objective response, PFS, and OS.
  
  
  CONCLUSIONS
  Most patients treated with BEV or BEV+CPT-11 on BRAIN did not experience a change from baseline in radiographic characteristics of disease at the time of progression.
authors.affiliation: Department of Radiologic Sciences, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, CHS, BL-428, Los Angeles, CA 90095-1721, USA. wpope@mednet.ucla.edu
authors.forename: W B
authors.initials: WB
authors.lastname: Pope
authors.forename: Q
authors.initials: Q
authors.lastname: Xia
authors.forename: V E
authors.initials: VE
authors.lastname: Paton
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.forename: J
authors.initials: J
authors.lastname: Hambleton
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Huo
authors.forename: M S
authors.initials: MS
authors.lastname: Brown
authors.forename: J
authors.initials: J
authors.lastname: Goldin
authors.forename: T
authors.initials: T
authors.lastname: Cloughesy
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin