The impact of different volumetric thresholds to determine progressive disease in patients with recurrent glioblastoma treated with bevacizumab. Issue 1 (9th March 2022)

• Record Type: Journal Article
• Authors: Gahrmann, Renske; Smits, Marion; Vernhout, René Michel; Taal, Walter; Kapsas, Giorgios; de Groot, Jan Cees; Hanse, Monique; Vos, Maaike; Beerepoot, Laurens Victor; Buter, Jan; Flach, Zwenneke Hendrieke; van der Holt, Bronno; van den Bent, Martin
• Is Part Of: Neuro-oncology advances. Volume 4:Issue 1(2022)
• Publication Date: 2022-03-09
• Subjects: bevacizumab -- GBM -- RANO -- volumetry; 616.99481
• DOI: 10.1093/noajnl/vdac032
• Languages: English
• ISSNs: 2632-2498

Abstract

Abstract: Background: The optimal volumetric threshold for determining progressive disease (PD) in recurrent glioblastoma is yet to be determined. We investigated a range of thresholds in association with overall survival (OS). Methods: First recurrent glioblastoma patients treated with bevacizumab and/or lomustine were included from the phase II BELOB and phase III EORTC26101 trials. Enhancing and nonenhancing tumor volumes were measured at baseline, first (6 weeks), and second (12 weeks) follow-up. Hazard ratios (HRs) for the appearance of new lesions and several thresholds for tumor volume increase were calculated using cox regression analysis. Results were corrected in a multivariate analysis for well-established prognostic factors. Results: At first and second follow-up, 138 and 94 patients respectively, were deemed eligible for analysis of enhancing volumes, while 89 patients were included in the analysis of nonenhancing volumes at first follow-up. New lesions were associated with a significantly worse OS (3.2 versus 11.2 months, HR = 7.03, P < .001). At first follow-up a threshold of enhancing volume increase of ≥20% provided the highest HR (5.55, p = .001. At second follow-up, any increase in enhancing volume (≥0%) provided the highest HR (9.00, p < .001). When measuring nonenhancing volume at first follow-up, only 6 additional patients were scored as PD with the highest HR of ≥25% increase in volume (HR=3.25, p = .008). Conclusion: Early appearing new lesions were associated with poor OS. Lowering the volumetric threshold for PD at both first and second follow-up improved survival prediction. However, the additional number of patients categorized as PD by lowering the threshold was very low. The per-RANO added change in nonenhancing volumes to the analyses was of limited value.