Background

The use of Bevacizumab in the treatment of high-grade glioma (HGG) may be changing with the results of two phase III trials showing progression free survival (PFS) benefit, and decreased steroid use, when Bevacizumab is given concurrently with chemo-radiation as first line treatment. Here the authors report their experience of using single-agent Bevacizumab third line in patients with recurrent HGG.

Method

Our institutional database was reviewed to identify all patients with a diagnosis of HGG commenced on Bevacizumab between July 2011 and May 2013. Patient notes and the chemotherapy prescribing system were used to collect data on time to progression, survival, toxicity and steroid use.

Results

Twelve patients were identified as having received Bevacizumab. Ten patients had a HGG at diagnosis and two had transformed low-grade tumours, as determined by MRI.

All patients had initial debulking surgery and seven had further redo debulking (five patients with insertion of Carmustine wafers). All had prior radical radiotherapy (60Gy in 30 fractions), Temozolomide and PCV (Procarbazine, CCNU, Vincristine) chemotherapy.

A median of 10 cycles of Bevacizumab (10mg/kg fortnightly) were given (range 3-42). One patient continues on treatment. Median PFS was 18.9 weeks (range 4-94), PFS at 6 months (PFS-6) 33% and median overall survival (OS) 30 weeks (range 22.4-49). None of the patients suffered ≥ grade 3 toxicity, 25% reported one or more at grade 2 (proteinuria, hypertension, bleeding, osteonecrosis), whilst 50% had grade 1 only (mainly proteinuria). Six patients reduced their Dexamethasone requirements during treatment.

Conclusion

Our results are comparable in terms of PFS-6, and slightly better for median PFS, compared to studies with a mixed pre-treatment group. OS is lower than published data but may reflect our heavily pre-treated population. The results indicate a clear role, with minimal toxicity, for single-agent Bevacizumab in recurrent HGG.