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Dixit KS, Sachdev S, Amidei C, et al. A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas. J Neurooncol. 2021;155(3):297-306doi: 10.1007/s11060-021-03875-8.
Dixit, K. S., Sachdev, S., Amidei, C., Kumthekar, P., Kruser, T. J., Gondi, V., Grimm, S., Lukas, R. V., Nicholas, M. K., Chmura, S. J., Fought, A. J., Mehta, M., & Raizer, J. J. (2021). A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas. Journal of neuro-oncology, 155(3), 297-306. https://doi.org/10.1007/s11060-021-03875-8
Dixit, Karan S, et al. "A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas." Journal of neuro-oncology vol. 155,3 (2021): 297-306. doi: https://doi.org/10.1007/s11060-021-03875-8
Dixit KS, Sachdev S, Amidei C, Kumthekar P, Kruser TJ, Gondi V, Grimm S, Lukas RV, Nicholas MK, Chmura SJ, Fought AJ, Mehta M, Raizer JJ. A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas. J Neurooncol. 2021 Dec;155(3):297-306. doi: 10.1007/s11060-021-03875-8. Epub 2021 Oct 24. PMID: 34689306.
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J Neurooncol. 2021 Dec;155(3):297-306. doi: 10.1007/s11060-021-03875-8. Epub 2021 Oct 24.

A multi-center prospective study of re-irradiation with bevacizumab and temozolomide in patients with bevacizumab refractory recurrent high-grade gliomas.

Journal of neuro-oncology

Karan S Dixit, Sean Sachdev, Christina Amidei, Priya Kumthekar, Tim J Kruser, Vinai Gondi, Sean Grimm, Rimas V Lukas, Martin Kelly Nicholas, Steven J Chmura, Angela J Fought, Minesh Mehta, Jeffrey J Raizer

Affiliations

  1. Division of Neuro-Oncology, Department of Neurology, Feinberg School of Medicine Northwestern University, Chicago, IL, 60611, USA. [email protected].
  2. Northwestern University, 710 N Lake Shore Drive, Abbott Hall Room 1123, Chicago, IL, 60611, USA. [email protected].
  3. Department of Radiation Oncology, Feinberg School of Medicine Northwestern University, Chicago, IL, 60611, USA.
  4. Department of Neurosurgery, Feinberg School of Medicine Northwestern University, Chicago, IL, 60611, USA.
  5. Division of Neuro-Oncology, Department of Neurology, Feinberg School of Medicine Northwestern University, Chicago, IL, 60611, USA.
  6. Department of Neurology, University of Chicago School of Medicine, Chicago, IL, 60637, USA.
  7. Department of Neurology and Rehabilitation, University of Illinois-Chicago School of Medicine, Chicago, IL, 60612, USA.
  8. Department of Radiation and Cellular Oncology, University of Chicago School of Medicine, Chicago, IL, 60637, USA.
  9. Department of Preventative Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL, 60611, USA.
  10. Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA.

PMID: 34689306 DOI: 10.1007/s11060-021-03875-8

Abstract

PURPOSE: Survival is dismal for bevacizumab refractory high-grade glioma patients. We prospectively investigated the efficacy of re-irradiation, bevacizumab, and temozolomide in bevacizumab-naïve and bevacizumab-exposed recurrent high-grade glioma, without volume limitations, in a single arm trial.

METHODS: Recurrent high-grade glioma patients were stratified based on WHO grade (4 vs. < 4) and prior exposure to bevacizumab (yes vs. no). Eligible patients received radiation using a simultaneous integrated boost technique (55 Gy to enhancing disease, 45 Gy to non-enhancing disease in 25 fractions) with bevacizumab 10 mg/kg every 2 weeks IV and temozolomide 75 mg/m

RESULTS: Fifty-four patients were enrolled. The majority (n = 36, 67%) were bevacizumab pre-exposed GBM. Median OS for all patients was 8.5 months and 7.9 months for the bevacizumab pre-exposed GBM group. Patients ≥ 36 months from initial radiation had a median OS of 13.3 months compared to 7.5 months for those irradiated < 36 months earlier (p < 0.01). FACT-Br and FACT-Fatigue scores initially declined during radiation but returned to pretreatment baseline. Treatment was well tolerated with 5 patients experiencing > grade 3 lymphopenia and 2 with > grade 3 thrombocytopenia. No radiographic or clinical radiation necrosis occurred.

CONCLUSIONS: Re-irradiation with bevacizumab and temozolomide is a safe and feasible salvage treatment for patients with large volume bevacizumab-refractory high-grade glioma. Patients further from their initial radiotherapy may derive greater benefit with this regimen.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords: Bevacizumab; Glioblastoma; Radiation; Re-irradiation; Recurrent glioma; Temozolomide

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