Re-irradiation combined with bevacizumab for recurrent glioblastoma beyond bevacizumab failure: survival outcomes and prognostic factors

Abstract

The combination of re-irradiation and bevacizumab has emerged as a potential therapeutic strategy for patients experiencing their first glioblastoma multiforme (GBM) recurrence. This study aims to assess the effectiveness of the re-irradiation and bevacizumab combination in treating second-progression GBM patients who are resistant to bevacizumab monotherapy. This retrospective study enrolled 64 patients who developed a second progression after single-agent bevacizumab therapy. The patients were divided into two groups: 35 underwent best supportive care (none-ReRT group), and 29 received bevacizumab and re-irradiation (ReRT group). The study measured the overall survival time after bevacizumab failure (OST-BF) and re-irradiation (OST-RT). Statistical tests were used to compare categorical variables, evaluate the difference in recurrence patterns between the two groups, and identify optimal cutoff points for re-irradiation volume. The results of the Kaplan–Meier survival analysis indicated that the re-irradiation (ReRT) group experienced a significantly higher survival rate and longer median survival time than the non-ReRT group. The median OST-BF and OST-RT were 14.5 months and 8.8 months, respectively, for the ReRT group, while the OST-BF for the none-ReRT group was 3.9 months (p < 0.001). The multivariable analysis identified the re-irradiation target volume as a significant factor for OST-RT. Moreover, the re-irradiation target volume exhibited excellent discriminatory ability in the area under the curve (AUC) analysis, with an optimal cutoff point of greater than 27.58 ml. These findings suggest that incorporating re-irradiation with bevacizumab therapy may be a promising treatment strategy for patients with recurrent GBM resistant to bevacizumab monotherapy. The re-irradiation target volume may serve as a valuable selection factor in determining which patients with recurrent GBM are likely to benefit from the combined re-irradiation and bevacizumab treatment modality.

Prognostic Factors for Progression-free Survival and Overall Survival After Recurrence of Glioblastoma

“…Previous studies that investigated potential prognostic factors of OS specifically for patients with recurrent glioblastoma (grade IV glioma) have produced partially conflicting results (2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). In 2012, Bloch et al presented a retrospective study of 107 patients who received resection of recurrent glioblastoma (8).…”

Understanding the Role of Endothelial Cells in Glioblastoma: Mechanisms and Novel Treatments

“…Similarly, intrathecal bivalent CAR-T cells targeting EGFR and IL13Rα2 in recurrent glioblastomas reported interim results showing manageable toxicity and encouraging progression-free survival [ 142 ]. Despite these early findings, challenges such as tumor heterogeneity, immune evasion mechanisms, and patient selection criteria have hindered the successful translation of these combination approaches into clinically meaningful outcomes [ 143 ].…”

Development of an MCL-1-related prognostic signature and inhibitors screening for glioblastoma

“…The survival time of most patients is much lower than that of patients with other tumors, and the quality of life is very poor ( Finch et al, 2021 ). At present, the conventional treatment methods for GBM include tumor resection, radiotherapy combined with temozolomide (TMZ) and targeted therapy with bevacizumab, etc., but these treatments have more or less obvious limitations ( Allahyarzadeh Khiabani et al, 2023 ; Boongird et al, 2023 ; Hotchkiss et al, 2023 ; Jatyan et al, 2023 ; You et al, 2023 ). Therefore, how to predict the prognosis of GBM patients more accurately and intervene the factors affecting the prognosis, formulate more reasonable and effective treatment plans, and develop safer and more effective drugs are the key to treating glioblastoma patients.…”