Salvage Chemotherapy with Bevacizumab for Recurrent Anaplastic Glioma
Pp. 127-132 (6)
Marc C. Chamberlain
Background: The treatment of recurrent anaplastic glioma (AG) like all high-grade gliomas (HGG) is problematic, as only partially effective therapeutic modalities are available and there is a lack of a standard therapy for recurrence. Methods: A literature review of the use of bevacizumab for recurrent HGG including five studies involving recurrent AG. Results: In the 5 studies of bevacizumab for the treatment of recurrent AG (n=140 patients) neuroradiographic response rates were as follows; complete response 0-20%, partial response 34-68% (median 52%), and stable disease 5-59% (median 16%). Median overall survival was 28 weeks (range 18-35 weeks) and progression free survival at 6- and 12-months was 55% (range 32-68%) and 23% (16-39%) respectively. Conclusions: Bevacizumab therapy appears to increase response of recurrent AG by 2-fold and 6- month progression free survival by 1.5 fold without a clear benefit with respect to overall survival. Toxicity of bevacizumab therapy is manageable and most often comprised of hypertension, proteinuria and fatigue. To date, there are no multi-institutional prospective trials evaluating the role of bevacizumab for the treatment of recurrent AG notwithstanding the increasingly common use of bevacizumab for this indication.
Department of Neurology and Neurological Surgery, Division of Neuro-Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, 825 Eastlake Avenue E, POB 19023, MS G4940, Seattle, WA 98109-1023