Abstract
OBJECTIVE
To investigate the efficacy, safety and application mode of bevacizumab in IDH wild-type adult patients with relapsed GBM.
METHODS
The clinical data of IDH wild-type adult patients with recurrent GBM who received bevacizumab monotherapy or combined chemotherapy in Sun Yat-sen University Cancer Center from 2011 to 2020 were retrospectively analyzed. The enrolled patients had recurred for the first time or multiple times after received surgery, radiotherapy and temozolomide. The objective curative effect was evaluated according to the evaluation criteria of response assessment in neuro-oncology(RANO). Kaplan-Meier method was used for survival analysis, Log-Rank test and Cox regression model were used for prognosis analysis. Adverse reactions were evaluated according to CTC 5.0 standard.
RESULTS
81 patients were enrolled, the objective response rate was 62.9%, the disease control rate was 80.2%, the median progression-free survival (PFS) was 4.4 months (95%CI: 4.0-4.8), and the median overall survival (OS) was 7.8 months (95%CI: 6.8-8.8). Univariate analysis showed that the number of recurrences, the dose of bevacizumab, and whether combined with chemotherapy had no effects on OS. Patients with disseminated tumors, KPS score ≥ 60, MGMT promoter methylation, and ki-67 < 30% had prolonged OS. Multivariate analysis showed that KPS score and MGMT promoter status were independent prognostic factors affecting OS. Major adverse events were mostly grade 1 to 2, including: myelosuppression, hypertension, elevated transaminases, nausea/vomiting, and constipation. No grade 4-5 adverse events occurred.
CONCLUSION
Bevacizumab therapy can improve the survival of IDH wild type adult patients with recurrent GBM and was well tolerated. Early or delayed use of bevacizumab after relapse, low-dose or high-dose usage, and whether combined with chemotherapy had no effect on the OS of patients. KPS score and MGMT methylation status were independent prognostic factors affecting OS.