Progression pattern and adverse events with bevacizumab in glioblastoma

• Published in: Current oncology (Toronto) Vol. 23; no. 5; pp. e468 - 471
• Main Authors: Mamo, A, Baig, A, Azam, M, Rho, Y S, Sahebjam, S, Muanza, T, Owen, S, Petrecca, K, Guiot, M C, Al-Shami, J, Sharma, R, Kavan, P
• Format: Journal Article
• Language: English
• Published: Canada Multimed Inc 01.10.2016
• Subjects: Original; bevacizumab; adverse events; Glioblastoma multiforme; patterns of progression; survival
• ISSN: 1198-0052; 1718-7729; 1718-7729
• DOI: 10.3747/co.23.3108

The use of bevacizumab in the management of glioblastoma multiforme (gbm) remains controversial. In Canada, bevacizumab is approved for the treatment of recurrent gbm. We describe a pattern of progression across treatment lines in gbm. During 2008-2014, 64 patients diagnosed with gbm were treated with bevacizumab at McGill University hospitals. Of those patients, 30 (46.9%) received bevacizumab in the first line (B1L), and 34 (53.1%) received it in the second line and beyond (B2L+). The average length of treatment with bevacizumab was 24.4 weeks (range: 0-232.7 weeks). The patterns of progression were categorized as local, distant, diffuse, multifocal, or multi-pattern. Local progression was seen in 46.7% of B1L patients and 26.5% of B2L+ patients, distant in 3.3% and 2.9%, diffuse in 20% and 47%, multifocal in 10% and 8.8%, and multi-pattern in 3.3% and 11.8%. No differences between the groups were observed for the distant ( = 0.3) or diffuse ( = 0.4) patterns. Grades 3 and 4 adverse events in the B1L and B2L+ groups were fatigue (33.3% vs. 17.6% respectively), hypertension (26.7% vs. 5.9%), thrombocytopenia (26.7% vs. 11.8%), neutropenia (26.7% vs. 11.8%), anemia (23.3% vs. 11.8%), leucopenia (20% vs. 8.8%), deep vein thrombosis (23.3% vs. 5.9%), seizure (16.7% vs. 8.8%), brain hemorrhage (6.7% vs. <1%), and delayed wound healing (6.7% vs. 2.9%). More total grades 3 and 4 adverse events occurred in the B1L group ( = 0.000519). In our cohort, patterns of progression were not different in B1L and B2L+ patients. Moreover, both groups experienced similar adverse events, although more grades 3 and 4 events occurred in the B1L group, implying that severe adverse events in B1L patients could negatively affect survival outcomes.