Abstract 361P
Background
Bevacizumab and chemotherapy are frequently used to treat recurrence of glioblastoma (GBM). However, the selection of the concomitant chemotherapeutic agent remains an open question.
Methods
All patients treated with at least one cycle of chemotherapy plus bevacizumab for recurrent GBM at the Georges-François Leclerc Cancer Centre in Dijon, France between June 2005 and August 2019 were included in this retrospective study. The primary and secondary objectives were progression-free survival (PFS) and overall survival (OS), respectively. As fotemustine is preponderant in the treatment of GBM, as recommended by the survival criteria, we compared this with other chemotherapy agent groups.
Results
A total of 160 patient files were analysed. One hundred patients received fotemustine (62.5%), 18 temozolomide (11.2%), seven lomustine (4.4%), and 35 irinotecan (21.9%). The majority were male (63.7%), and the mean age was 59.8 years. Further, 81% of patients had a Karnofsky performance status ≥90, and 43% had undergone initial surgical resection. All patients received the first-line Stupp regimen. In the whole cohort, the median PFS was 4.5 months [2.7-8.5] and median OS was 9 months [4.5-23]. Only MGMT (methyl guanine methyltransferase) unmethylated status was associated with poor PFS upon univariate analysis. For OS, fotemustine treatment was associated with poor survival: 7.3 mo vs 19.9 mo (HR=2.13[1.23-3.7], p=0.006). In the fotemustine group, steroid usage at baseline was associated with poor survival: median OS of 6.7 mo vs not reached (HR=2.9 [1.1-7.3], p=0.03). Similarly, in the low Karnofsky performance status subgroup, fotemustine treatment was associated with poor OS: median OS of 4.3 mo vs not reached, (HR=4.5 [1.3-16.7], p=0.02).
Conclusions
Using real-life data, this study shows the worst efficacy of the addition of fotemustine to bevacizumab compared with other added chemotherapeutic agents. We find that in patients with low-performance status, a concomitant steroid treatment other than an alkylating agent or irinotecan is a better choice for combo-therapy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.