Outcomes of salvage fractionated re-irradiation combined with bevacizumab for recurrent high-grade gliomas that progressed after bevacizumab treatment**. (6th May 2021)

• Record Type: Journal Article
• Authors: Yonezawa, Hajime; Ohno, Makoto; Igaki, Hiroshi; Miyakita, Yasuji; Takahashi, Masamichi; Tamura, Yukie; Shima, Satoshi; Matsushita, Yuko; Ichimura, Koichi; Narita, Yoshitaka
• Is Part Of: Japanese journal of clinical oncology. Volume 51:Number 7(2021)
• Page Start: 1028
• Page End: 1035
• Publication Date: 2021-05-06
• Subjects: bevacizumab -- disease progression -- glioma -- re-irradiation -- treatment failure; Oncology -- Periodicals; Cancer -- Periodicals; 616.994005
• DOI: 10.1093/jjco/hyab063
• Languages: English
• ISSNs: 0368-2811

Abstract

Abstract: Background: There is no standard treatment for patients with recurrent high-grade gliomas who progress after bevacizumab treatment. We evaluated the outcomes of re-irradiation combined with bevacizumab for patients refractory to bevacizumab. Methods: Between January 2015 and September 2019, patients with progression after bevacizumab treatment were treated with re-irradiation combined with bevacizumab (25 Gy in five fractions). Results: Fourteen patients [glioblastoma, isocitrate dehydrogenase (IDH) wild type ( N = 6), glioblastoma, IDH mutant ( N = 4), anaplastic astrocytoma, IDH wild type ( N = 1), anaplastic astrocytoma, IDH mutant ( N = 1), glioblastoma, not otherwise specified ( N = 1) and radiologically diagnosed brainstem glioma ( N = 1)] were included in this study. The median survival and progression-free survival times after re-irradiation combined with bevacizumab were 6.1 and 3.8 months, respectively. The 6-month survival and progression-free survival rates were 54.5 and 15.7%, respectively. Patients with a Karnofsky performance status of ≥70 tended to have longer median survival time (9.3 vs. 5.4 months, respectively; P = 0.058) and had a significantly longer median progression-free survival time (4.2 vs. 3.7 months, respectively; P = 0.046) than those with a Karnofsky performance status of <70. Four patients (28.6%) achieved a complete or partial radiological response, and three patients (21.4%) had an improved Karnofsky performance status after re-irradiation combined with bevacizumab. Grade 3/4 toxicities included leukopenia in four patients (28.6%), hypertension in three (21.4%), proteinuria in one (7.1%) and gastrointestinal hemorrhage in one (7.1%). Conclusions: Re-irradiation combined with bevacizumab for patients with recurrent high-grade gliomas who progress after bevacizumab treatment was feasible. Re-irradiation combined with bevacizumab is a potential treatment option, especially for patients with a Karnofsky performance status of ≥70. Abstract : Re-irradiation combined with bevacizumab is a potential treatment option for patients with recurrent high-grade gliomas who progress after bevacizumab treatment.