Add-on bevacizumab can prevent early clinical deterioration and prolong survival in newly diagnosed partially resected glioblastoma patients with a poor performance status.
OBJECTIVE
The AVAglio trial established the beneficial effect of add-on bevacizumab (BEV) for the treatment of newly diagnosed glioblastomas (nd-GBMs) that led to the approval of BEV for the treatment of these patients in Japan. However, the rationality of using BEV as a first-line treatment for nd-GBMs remains controversial. The purpose of this study was to analyze the outcomes of a case series of nd-GBM patients.


METHODS
The outcomes of 69 nd-GBM patients treated after 2006 were retrospectively analyzed. Clinical and genetic analyses were performed, and estimates of progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Since add-on BEV therapy was only used for partially resected GBMs (pr-GBMs) after its approval in 2013, the patients were subdivided into 3 treatment groups: Type I, partial removal with temozolomide (TMZ)/BEV and concurrent radiotherapy (CCRT); Type II, partial removal with TMZ and CCRT; and Type III, gross total removal with TMZ and CCRT.


RESULTS
The PFS rate of Type I patients was significantly higher than that of Type II patients (P=0.014), but comparable to that of Type III patients. Differences in OS rates between Type I and Type II patients were less apparent (P=0.075), although the median OS of Type I patients was ~8 months higher than that of Type II patients (17.4 vs 9.8 months, respectively). The clinical deterioration rate during initial treatment was significantly (P=0.024) lower in Type I than in Type II patients (7.7% vs 47.4%, respectively). Differences in OS rates between Type I and Type II patients with a poor performance status (PS) were significant (P=0.017).


CONCLUSIONS
Our findings suggest that add-on BEV can prevent early clinical deterioration of pr-GBM patients and contribute to a prolonged survival, especially for those with a poor PS.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University; Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center.
Nobuhiro
N
Hata
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Koji
K
Yoshimoto
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Ryusuke
R
Hatae
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Daisuke
D
Kuga
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Yojiro
Y
Akagi
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Yuhei
Y
Sangatsuda
Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University.
Satoshi O
SO
Suzuki
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University; Department of Neurosurgery, Harasanshin Hospital, Fukuoka.
Tadahisa
T
Shono
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University; Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
Masahiro
M
Mizoguchi
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Koji
K
Iihara
bevacizumab; glioblastoma; performance status; survival; unresectable