Changes in the Relapse Pattern and Prognosis of Glioblastoma After Approval of First-Line Bevacizumab: A Single-Center Retrospective Study

贝伐单抗 医学 危险系数 内科学 单中心 肿瘤科 胶质母细胞瘤 单变量分析 回顾性队列研究 无进展生存期 多元分析 外科
作者
Yusuke Funakoshi,Nobuhiro Hata,Daisuke Kuga,Ryusuke Hatae,Yuhei Sangatsuda,Yutaka Fujioka,Kosuke Takigawa,Ryosuke Otsuji,Aki Sako,Tsuyoshi Yoshitake,Osamu Togao,Akio Hiwatashi,Toru Iwaki,Masahiro Mizoguchi,Koji Yoshimoto
出处
期刊:World Neurosurgery [Elsevier BV]
卷期号:159: e479-e487 被引量:2
标识
DOI:10.1016/j.wneu.2021.12.075
摘要

Controversies exist regarding the aggressive recurrence of glioblastoma after bevacizumab treatment. We analyzed the clinical impact of bevacizumab approval in Japan by evaluating the clinical course and relapse pattern in patients with glioblastoma.We included 100 patients with IDH-wild-type glioblastoma from September 2006 to February 2018 in our institution. The patients were classified into the pre-bevacizumab (n = 51) and post-bevacizumab (n = 49) groups. Overall, progression-free, deterioration-free, and postprogression survivals were compared. We analyzed the relapse pattern of 72 patients, whose radiographic progressions were evaluated.Significant improvement in progression-free (pre-bevacizumab, 7.5 months; post-bevacizumab, 9.9 months; P = 0.0153) and deterioration-free (pre-bevacizumab, 8.5 months; post-bevacizumab, 13.8 months; P = 0.0046) survivals was seen. These survival prolongations were strongly correlated (r: 0.91, P < 0.0001). The nonenhancing tumor pattern was novel in the post-bevacizumab era (5 of 33). The presence of a nonenhancing tumor did not indicate poor postprogression survival (hazard ratio: 0.82 [0.26-2.62], P = 0.7377). The rate of early focal recurrence was significantly lower (P = 0.0155) in the post-bevacizumab (4 of 33) than in the pre-bevacizumab (18 of 39) era. There was a significant decrease in early focal recurrence after approval of bevacizumab in patients with unresectable tumors (P = 0.0110). The treatment era was significantly correlated with a decreased rate of early focal recurrence (P = 0.0021, univariate analysis; P = 0.0144, multivariate analysis).Approval of first-line bevacizumab in Japan for unresectable tumors may prevent early progression and clinical deterioration of glioblastoma without worsening the clinical course after relapse.
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