Progression pattern and adverse events with bevacizumab in glioblastoma.
BACKGROUND
The use of bevacizumab in the management of glioblastoma multiforme (gbm) remains controversial. In Canada, bevacizumab is approved for the treatment of recurrent gbm. We describe a pattern of progression across treatment lines in gbm.


METHODS
During 2008-2014, 64 patients diagnosed with gbm were treated with bevacizumab at McGill University hospitals. Of those patients, 30 (46.9%) received bevacizumab in the first line (B1L), and 34 (53.1%) received it in the second line and beyond (B2L+). The average length of treatment with bevacizumab was 24.4 weeks (range: 0-232.7 weeks). The patterns of progression were categorized as local, distant, diffuse, multifocal, or multi-pattern.


RESULTS
Local progression was seen in 46.7% of B1L patients and 26.5% of B2L+ patients, distant in 3.3% and 2.9%, diffuse in 20% and 47%, multifocal in 10% and 8.8%, and multi-pattern in 3.3% and 11.8%. No differences between the groups were observed for the distant (p= 0.3) or diffuse (p= 0.4) patterns. Grades 3 and 4 adverse events in the B1L and B2L+ groups were fatigue (33.3% vs. 17.6% respectively), hypertension (26.7% vs. 5.9%), thrombocytopenia (26.7% vs. 11.8%), neutropenia (26.7% vs. 11.8%), anemia (23.3% vs. 11.8%), leucopenia (20% vs. 8.8%), deep vein thrombosis (23.3% vs. 5.9%), seizure (16.7% vs. 8.8%), brain hemorrhage (6.7% vs. <1%), and delayed wound healing (6.7% vs. 2.9%). More total grades 3 and 4 adverse events occurred in the B1L group (p= 0.000519).


CONCLUSIONS
In our cohort, patterns of progression were not different in B1L and B2L+ patients. Moreover, both groups experienced similar adverse events, although more grades 3 and 4 events occurred in the B1L group, implying that severe adverse events in B1L patients could negatively affect survival outcomes.
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
A
A
Mamo
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
A
A
Baig
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
M
M
Azam
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
Y S
YS
Rho
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
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S
Sahebjam
Radiation Oncology, Jewish General Hospital, McGill University Health Centre, Montreal, QC.
T
T
Muanza
Department of Oncology, McGill University Health Centre, Montreal, QC.
S
S
Owen
Neurosurgery, Montreal Neurological Institute, Montreal, QC.
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K
Petrecca
Pathology, McGill University Health Centre, Montreal, QC.
M C
MC
Guiot
Clinical Research, McGill University Health Centre, Montreal, QC.
J
J
Al-Shami
Clinical Research, McGill University Health Centre, Montreal, QC.
R
R
Sharma
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
P
P
Kavan
Glioblastoma multiforme; adverse events; bevacizumab; patterns of progression; survival