Retrospective Analysis of Bevacizumab in Combination With Ifosfamide, Carboplatin, and Etoposide in Patients With Second Recurrence of Glioblastoma

Abstract

Bevacizumab has been reported to be effective for recurrent glioblastoma. In our hospital, ifosfamide, carboplatin, etoposide (ICE) is the second-line chemotherapy for first recurrence of glioblastoma after temozolomide failure. In the present analysis, we retrospectively investigated the feasibility and effectiveness of bevacizumab combined with ICE in patients with glioblastoma at second relapse during ICE treatment. Between 2010 and 2012, tumor progressions were diagnosed in consecutive 8 patients who were treated with ICE for the first recurrence of glioblastoma. These patients were administered 3 cycles of 10 mg/kg bevacizumab every two weeks in combination with ICE treatment. The objective response rate of bevacizumab combination was 75% in Neuro-Oncology Working Group (RANO criteria), including complete response and partial response. Median progression free survival (PFS) and median overall survival (OS) after second relapse were 3.7 months (95% confidence interval [CI], 2.5–18.5 months) and 6.0 months (95% CI, 3.2–19.7 months), respectively. The 6-month PFS rates were 25% (95% CI, 0–55.0%). The median OS after initial diagnosis was 23.3 months (95% CI, 16.2–55.8 months). The grade 2 or 3 hematologic adverse events were identified in 7 of 8 patients, most of which might be due to ICE chemotherapy. The results of our retrospective analysis suggest that combination treatment with bevacizumab and ICE may be safe and beneficial in patients with recurrent glioblastoma.

Retrospective Analysis of Bevacizumab in Combination with Fotemustine in Chinese Patients with Recurrent Glioblastoma Multiforme

“…Recently, several prospective and retrospective studies provided clinical data on BEV activity both as single agent and in combination therapy, establishing this antiangiogenetic agent as a valuable and active treatment option in GBM [ 12 – 14 ]. The choice of FTM, as the chemotherapy agent combined with BEV, was based on the rational that BEV might enhance the delivery of an active cytotoxic drug, and adequate safety would be expected with this regimen due to nonoverlapping primary toxicities of each of the agents [ 15 ].…”

Infrequent RAS mutation is not associated with specific histological phenotype in gliomas

“…After discharge, she received maintenance therapy with temozolomide and bevacizumab. However, she showed progressive disease 29 months after the first surgery and received bevacizumab in combination with ifosfamide, carboplatin, and etoposide (ICE) [ 37 ]. The tumour kept growing slowly, and she died 49 months after the first surgery.…”

Disentangling the therapeutic tactics in GBM: From bench to bedside and beyond

“…It was observed that the median PFS was considerably higher by 2.8 months in patients who received RT + Bev than those who received RT alone, following surgery (Wirsching et al, 2018). Propelled by this success, several phase II trials have been reported using Bev along with irinotecan (Friedman et al, 2009), TMZ (Desjardins et al, 2012), sorafenib (Galanis et al, 2013), cetuximab and irinotecan (Hasselbalch et al, 2010), temsirolimus (Lassen et al, 2013), carboplatin and irinotecan (Reardon et al, 2011), etoposide (Reardon et al, 2009), erlotinib (Sathornsumetee et al, 2010), fotemustine (Soffietti et al, 2014), and ifosfamide along with carboplatin and etoposide (Arakawa et al, 2013) in patients with recurrent GBM. However, in phase II randomized trial (CABARET), involving patients with recurrent GBM, it was reported that following treatment with Bev the median OS was only 3–3.4 months, thereby giving notion that Bev treatment did not improve the OS and PFS in recurrent GBM (Hovey et al, 2015).…”