530P - Ultra low bevacizumab (BEVULTRA-100) as a novel approach in symptomatic management of high grade glioma: Can minimal dose make a difference?

Background

High grade gliomas are primary malignant brain tumors where surgery followed by radiotherapy and chemotherapy remains the standard of care. Majority of patients manifest with post treatment changes like necrosis, edema or pseudoprogression for which the management is challenging. Currently steroids remain the treatment of choice in such scenarios but have many dose limiting toxicities. Bevacizumab (BEV) is approved in recurrent HGG. Fewer studies with dose de escalation up to 50% of standard dose have attained similar results in control. However it's anti angiogenic/anti edema effect is quite unexplored in management of post treatment changes. In our study, we analyzed the role of BEVULTRA-100 in symptomatic/asymptomatic HGG as an alternative to steroids.

Methods

In this prospective, interventional single arm study, 117 patients of HGG treated with chemotherapy and radiotherapy as primary modality from July 2013 till April 2023 were included. All patients received Ultra-Low Dose Bevacizumab - 100 mg once in every month along with oral temozolomide. Complete blood counts and vitals were monitored before each cycle. All patients were assessed at regular intervals for clinical and imaging parameters-DOPA PETCT & MRI in regards with post treatment changes.

Results

Median age was 44.5 years Range: 9 to 70. M:F ratio of 1.54 :1. A Median of 12 cycles UltraBEV (Range:1 to 62) were received (1514 cycles in total). All patients tolerated well without any significant toxicities. None of the patients had intracranial/ tumoral bleed. Use of steroids was markedly reduced in more than 90% patients with BEVULTRA-100 resulting in substantial improvement in the QOL. Similar pattern was observed in imaging parameters including reduction of post treatment edema.

Conclusions

This pilot study aims at providing a proof of concept for BEVUltra100 in management of post treatment changes in HGGs. This is a feasible, cost effective option with better compliance compared to steroids with improved survival. This study also paves a trailblazing path for exploring the field of radiation dose escalation and reirradiation with adequate control over toxicities improving the QOL, which might translate into improved survival.

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.