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 Volume 72, Number 14, April 7, 2009
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NEUROLOGY 2009;72:1217-1222
© 2009 American Academy of Neurology

Bevacizumab and chemotherapy for recurrent glioblastoma

A single-institution experience

P. L. Nghiemphu, MD, W. Liu, MS, Y. Lee, PhD, T. Than, BS, C. Graham, MSN, A. Lai, MD, PhD, R. M. Green, MD, W. B. Pope, MD, PhD, L. M. Liau, MD, PhD, P. S. Mischel, MD, S. F. Nelson, MD, R. Elashoff, PhD and T. F. Cloughesy, MD

From the Departments of Neurology (P.L.N., T.T., C.G., A.L., T.F.C.), Biomathematics (W.L., R.E.), Human Genetics (Y.L., S.F.N.), Radiological Sciences (W.B.P.), Neurological Surgery (L.M.L.), and Pharmacology and Laboratory Medicine (P.S.M.), Jonsson Comprehensive Cancer Center (P.L.N., A.L., P.S.M., S.F.N., R.E., T.F.C.), University of California at Los Angeles and David Geffen School of Medicine at the University of California at Los Angeles, CA; and Department of Neurology (R.M.G.), Kaiser Permanente Los Angeles Medical Center, CA.

Address correspondence and reprint requests to Dr. Phioanh (Leia) Nghiemphu, UCLA Neuro-Oncology, 710 Westwood Plaza, RNRC 1-230, Los Angeles, CA 90095

Objective: Bevacizumab has been shown to be effective in the treatment of recurrent glioblastoma in combination with chemotherapy compared with historic controls but not in randomized trials.

Methods: We conducted a retrospective analysis of patients treated for recurrent glioblastoma with bevacizumab vs a control group of patients, comparing progression-free survival (PFS) and overall survival (OS) between the two groups, and performed subgroup analysis based on age and performance status. Expression of vascular endothelial growth factor (VEGF) based on age was examined using DNA microarray analysis. We also evaluated the impact of bevacizumab on quality of life.

Results: We identified 44 patients who received bevacizumab and 79 patients who had not been treated with bevacizumab. There was a significant improvement in PFS and OS in the bevacizumab-treated group. Patients of older age (≥55 years) and poor performance status (Karnofsky Performance Status ≤80) had significantly better PFS when treated with bevacizumab, and bevacizumab-treated older patients had significantly increased OS. VEGF expression was significantly higher in older glioblastoma patients (aged ≥55 years). Patients treated with bevacizumab also required less dexamethasone use and maintained their functional status longer than the control group.

Conclusions: Bevacizumab in combination with chemotherapy may be a more effective treatment for recurrent glioblastoma and warrants further randomized prospective studies to determine its effect on survival. Bevacizumab also has more effect in those with older age and might reflect biologic differences in glioblastoma in different age groups as seen with the expression of vascular endothelial growth factor.

GBM = glioblastoma; HR = hazard ratio; KPS = Karnofsky Performance Status; OS = overall survival; PFS = progression-free survival; VEGF = vascular endothelial growth factor.

Leian{at}ucla.edu

Supplemental data at www.neurology.org

This work received grant support from Brain Tumor Funders’ Collaborative and was also supported by the Harry Allgauer Foundation through The Doris R. Ullmann Fund for Brain Tumor Research Technologies, the Henry E. Singleton Brain Tumor Foundation, a generous donation from the Ziering Family Foundation in memory of Sigi Ziering, Art of the Brain, and the Roven Family Fund in memory of Dawn Steel.

Disclosure: T.F.C. receives research grant funding from Genentech and has received an honorarium from Genentech.

Medications: Medications used in this study are listed at the end of the article.

Received August 12, 2008. Accepted in final form December 16, 2008.




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