Similar overall survival with reduced vs. standard dose bevacizumab monotherapy in progressive glioblastoma Journal Article
| Authors: | Gleeson, J. P.; Keane, F.; Keegan, N. M.; Mammadov, E.; Harrold, E.; Alhusaini, A.; Harte, J.; Eakin-Love, A.; O'Halloran, P. J.; MacNally, S.; Hennessy, B. T.; Breathnach, O. S.; Grogan, L.; Morris, P. G. |
| Article Title: | Similar overall survival with reduced vs. standard dose bevacizumab monotherapy in progressive glioblastoma |
| Abstract: | Introduction: Bevacizumab has demonstrated activity in glioblastoma (GBM), but the true benefits and optimal dose-schedule are debated. A lower dose-schedule than standard-dose bevacizumab (10 mg/kg 2-weekly) might offer similar benefits with lower costs. At our Institution, patients are randomly assigned at time of primary diagnosis to Neuro-Oncologists, who have varying practices in terms of bevacizumab dose-schedule upon progression. Methods: In a retrospective analysis we examined overall survival (OS), measured from first administered bevacizumab dose until death, according to dose-schedule. Patients with de novo WHO Grade IV GBM who received standard- or reduced-dose (5 mg/kg 2-weekly) bevacizumab were included. MGMT methylation status and time from diagnosis to bevacizumab start were examined as prognostic variables. Clinical benefit and a comparative cost analysis were assessed. Results: In total, 1127 bevacizumab doses were administered to 118 patients [Median: 7, Range: 1-44]. Median OS (mOS) was 5.8 months. 69 (59%) patients received standard-dose bevacizumab (mOS: 5.97 months) and 49 patients received reduced-dose (mOS: 5.7 months). No statistically significant difference in OS between dosing schedule was seen (HR: 1.11, P-value:.584). Patients with MGMT methylated tumors (43%) had improved OS compared to those with unmethylated tumors; 7.03 vs 4.97 months (HR: 0.61, P-value:.027). If all patients were treated with reduced-dose bevacizumab, an estimated €2.4M cost reduction would be observed. Conclusions: In this retrospective study, reduced-dose bevacizumab schedule resulted in similar OS to standard-dose bevacizumab monotherapy with substantial cost savings. MGMT methylation appears to convey a survival benefit in the setting of bevacizumab treatment for progressive GBM. © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. |
| Keywords: | adult; controlled study; aged; major clinical study; methylation; overall survival; disease course; bevacizumab; drug dose reduction; monotherapy; cancer grading; retrospective study; cost control; drug cost; dosage schedule comparison; glioblastoma; intermethod comparison; hazard ratio; methylated dna protein cysteine methyltransferase; mgmt; cost analysis; very elderly; human; male; female; priority journal; article; reduced dose |
| Journal Title: | Cancer Medicine |
| Volume: | 9 |
| Issue: | 2 |
| ISSN: | 2045-7634 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2020-01-01 |
| Start Page: | 469 |
| End Page: | 475 |
| Language: | English |
| DOI: | 10.1002/cam4.2616 |
| PUBMED: | 31756059 |
| PROVIDER: | scopus |
| PMCID: | PMC6970030 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 March 2020 -- Source: Scopus |
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