title: Bevacizumab continuation beyond initial bevacizumab progression among recurrent glioblastoma patients.
abstract: BACKGROUND
  Bevacizumab improves outcome for most recurrent glioblastoma patients, but the duration of benefit is limited and survival after initial bevacizumab progression is poor. We evaluated bevacizumab continuation beyond initial progression among recurrent glioblastoma patients as it is a common, yet unsupported practice in some countries.
  
  
  METHODS
  We analysed outcome among all patients (n=99) who received subsequent therapy after progression on one of five consecutive, single-arm, phase II clinical trials evaluating bevacizumab regimens for recurrent glioblastoma. Of note, the five trials contained similar eligibility, treatment and assessment criteria, and achieved comparable outcome.
  
  
  RESULTS
  The median overall survival (OS) and OS at 6 months for patients who continued bevacizumab therapy (n=55) were 5.9 months (95% confidence interval (CI): 4.4, 7.6) and 49.2% (95% CI: 35.2, 61.8), compared with 4.0 months (95% CI: 2.1, 5.4) and 29.5% (95% CI: 17.0, 43.2) for patients treated with a non-bevacizumab regimen (n=44; P=0.014). Bevacizumab continuation was an independent predictor of improved OS (hazard ratio=0.64; P=0.04).
  
  
  CONCLUSIONS
  The results of our retrospective pooled analysis suggest that bevacizumab continuation beyond initial progression modestly improves survival compared with available non-bevacizumab therapy for recurrent glioblastoma patients require evaluation in an appropriately randomised, prospective trial.
authors.affiliation: Department of Surgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA. dreardon3@partners.org
authors.forename: D A
authors.initials: DA
authors.lastname: Reardon
authors.forename: J E
authors.initials: JE
authors.lastname: Herndon
authors.forename: K B
authors.initials: KB
authors.lastname: Peters
authors.forename: A
authors.initials: A
authors.lastname: Desjardins
authors.forename: A
authors.initials: A
authors.lastname: Coan
authors.forename: E
authors.initials: E
authors.lastname: Lou
authors.forename: A L
authors.initials: AL
authors.lastname: Sumrall
authors.forename: S
authors.initials: S
authors.lastname: Turner
authors.forename: E S
authors.initials: ES
authors.lastname: Lipp
authors.forename: S
authors.initials: S
authors.lastname: Sathornsumetee
authors.forename: J N
authors.initials: JN
authors.lastname: Rich
authors.forename: J H
authors.initials: JH
authors.lastname: Sampson
authors.forename: A H
authors.initials: AH
authors.lastname: Friedman
authors.forename: S T
authors.initials: ST
authors.lastname: Boulton
authors.forename: D D
authors.initials: DD
authors.lastname: Bigner
authors.forename: H S
authors.initials: HS
authors.lastname: Friedman
authors.forename: J J
authors.initials: JJ
authors.lastname: Vredenburgh
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000188:drug therapy*; D018450:Disease Progression; D004334:Drug Administration Schedule; D005909:Glioblastoma / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab