Second-Line Chemotherapy in Recurrent Glioblastoma: A 2-Cohort Study.
BACKGROUND
Glioblastoma (GB) is the most common malignant primary central nervous system tumor in adults. Standard-of-care therapy includes surgical resection, radiotherapy and temozolomide, but nearly all patients experience disease progression. The purpose of this study was to describe 2 cohorts of patients with recurrent GB submitted to second-line treatment with procarbazine/lomustine/vincristine (PCV) or bevacizumab/irinotecan (BI).


METHODS
Retrospective analysis of GB patients treated in our center with PCV or BI, after progression with temozolomide, between 2004 and 2012.


RESULTS
Among 60 patients, 41 were treated with BI and 19 with PCV. According to the Macdonald criteria, the overall response rate in the BI group was 66% (n = 27) while it was 11% (n = 2) in the PCV group. The median progression-free survival was 5 and 3 months in the BI and PCV group, respectively. The median overall survival (OS) since second-line chemotherapy was 9 months in the BI group and 5 months in the PCV group. The latter group had a worse toxicity profile (grade 3-4: 52.6% vs. 22.0%; grade 1-2: 89.5% vs. 68.3%).


CONCLUSIONS
The BI cohort had higher response rates, almost twice the OS and a lower degree of toxicity in contrast to the PCV group. The small number of patients and historical cohorts limits these comparisons.
Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal.
Bruno F
BF
Carvalho
Ana C
AC
Fernandes
Daniela S
DS
Almeida
Luísa V
LV
Sampaio
Andreia
A
Costa
Claudia
C
Caeiro
Lígia
L
Osório
Lígia
L
Castro
Paulo
P
Linhares
Margarida
M
Damasceno
Rui C
RC
Vaz
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000068258:Bevacizumab / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D000077146:Irinotecan; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality*; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D011344:Procarbazine / Q000008:administration & dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D000068258:Bevacizumab; D011344:Procarbazine; D014750:Vincristine; D000077146:Irinotecan; D008130:Lomustine; D002166:Camptothecin