title: Prognostic factors in recurrent glioblastoma patients treated with bevacizumab.
abstract: The value of bevacizumab (BEV) in recurrent glioblastoma is unclear. Imaging parameters and progression-free survival (PFS) are problematic endpoints. Few data exist on clinical factors influencing overall survival (OS) in unselected patients with recurrent glioblastoma exposed to BEV. We retrospectively analyzed 174 patients with recurrent glioblastoma treated with BEV at two German brain tumor centers. We evaluated general patient characteristics, MGMT status, pretreatment, concomitant oncologic treatment and overall survival. Karnofsky performance score, number of prior chemotherapies, number of prior recurrences and combined treatment with irinotecan (IRI) were significantly associated with OS in univariate analysis. We did not find differences in OS related to sex, age, histology, MGMT status, prior surgical treatment or number of prior radiotherapies. Combined treatment with IRI and higher KPS both remained significantly associated with prolonged survival in multivariate analysis, but patients receiving IRI co-treatment had less advanced disease. Grouping into clinically relevant categories revealed an OS of 16.9 months from start of BEV in patients with first recurrence and KPS ≥ 80 % (n = 25). In contrast, in patients with second recurrence and KPS < 80 %, OS was 3.6 months (n = 27). Our observational data support an early use of BEV in patients with good performance status. The benefit of co-treatment with IRI in our cohort seems to be the result of biased patient recruitment.
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Schaub
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Tichy
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.|Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Schäfer
authors.affiliation: Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.
authors.forename: Kea
authors.initials: K
authors.lastname: Franz
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
authors.forename: Frederic
authors.initials: F
authors.lastname: Mack
authors.affiliation: Institute of Neurology (Edinger-Institute), Goethe University Hospital, Frankfurt, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Mittelbronn
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.|Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Sied
authors.initials: S
authors.lastname: Kebir
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Anna-Luisa
authors.initials: AL
authors.lastname: Thiepold
authors.affiliation: Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Waha
authors.affiliation: Institute of Biostatistics and Mathematical Modeling, Goethe University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Natalie
authors.initials: N
authors.lastname: Filmann
authors.affiliation: Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Banat
authors.affiliation: Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Steinbach
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Herrlinger
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieger
authors.affiliation: Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany. martin.glas@ukb.uni-bonn.de.|Stem Cell Pathologies Group, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Bonn, Germany. martin.glas@ukb.uni-bonn.de.|Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Klinik, Bonn, Germany. martin.glas@ukb.uni-bonn.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Glas
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt, Germany. oliver.baehr@med.uni-frankfurt.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bähr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D000077146:Irinotecan; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000074322:Antineoplastic Agents, Immunological; D000972:Antineoplastic Agents, Phytogenic; D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin
keywords: Bevacizumab; Irinotecan; Karnofsky performance score; Recurrent glioblastoma; Survival