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Re-irradiation strategies in combination with bevacizumab for recurrent malignant glioma

  • Clinical Study
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Abstract

The place of bevacizumab (BEV) in salvage re-irradiation (Re-RT) settings of malignant glioma is poorly defined. In the current study risk/benefit profiles of two BEV-based Re-RT protocols were analyzed and compared with that of salvage BEV plus irinotecan (BEV/IRI). According to interdisciplinary tumor board recommendations, patients were assigned to one of three BEV-based treatment protocols: (1) BEV/IRI, (2) Re-RT (36 Gy/18 fx) with concomitant BEV (Re-RT/BEV), and (3) Re-RT with concomitant/maintenance BEV (Re-RT/BEV→BEV). Prognostic factors were obtained from proportional hazards models. Adverse events were classified according to the NCI CTCAE, v4.0. 105 consecutive patients were enrolled from 08/2008 to 05/2014. Patients undergoing Re-RT experienced longer time intervals from initial diagnosis to BEV treatment (median: 22.0 months vs. 13.7 months, p = 0.001); those assigned to Re-RT/BEV→BEV rated better on the performance scale (median KPSREC: 90 vs. 70, p = 0.013). Post-recurrence survival after BEV-based treatment (PRS) was longest after Re-RT/BEV→BEV (median: 13.1 months vs. 8 months, p = 0.006). PRS after Re-RT/BEV and BEV/IRI was similar. Multivariately, higher KPSREC and Re-RT/BEV→BEV were associated with longer PRS. Treatment toxicity did not differ among groups. Re-RT/BEV→BEV is safe, feasible and effective and deserves further prospective evaluation.

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Authors and Affiliations

  1. Department of Neurosurgery, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Oliver Schnell, Jun Thorsteinsdottir, Markus Lenski, Jörg-Christian Tonn & Friedrich Wilhelm Kreth

  2. Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Daniel Felix Fleischmann, Claus Belka & Maximilian Niyazi

  3. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

    Daniel Felix Fleischmann, Claus Belka & Maximilian Niyazi

  4. MVZ Onkologie im Elisenhof, Prielmayerstr. 1, 80335, Munich, Germany

    Wolfgang Abenhardt

  5. Center for Neuropathology and Prion Research, LMU Munich, Feodor-Lynen-Str. 20, 81377, Munich, Germany

    Armin Giese

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  1. Oliver Schnell
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  2. Jun Thorsteinsdottir
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Correspondence to Maximilian Niyazi.

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Oliver Schnell and Jun Thorsteinsdottir have equally contributed to this study.

All authors except WA are members of the CCC Neuro-Oncology, LMU Munich.

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Schnell, O., Thorsteinsdottir, J., Fleischmann, D.F. et al. Re-irradiation strategies in combination with bevacizumab for recurrent malignant glioma. J Neurooncol 130, 591–599 (2016). https://doi.org/10.1007/s11060-016-2267-x

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  • DOI: https://doi.org/10.1007/s11060-016-2267-x

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