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Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma
Clinical Oncology xxx (2015) 1e2 Contents lists available at ScienceDirect
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letter
Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma Sir e The role of bevacizumab in patients with recurrent glioblastoma (rGBM) remains controversial [1]. Although often used in many European countries [2], its efficacy has not been compared with a combination of procarbazine, lomustine and, vincristine (PCV), a commonly used
chemotherapy regimen in this setting in the UK. We present outcomes comparing these agents in rGBM and recurrent grade III tumour (rGIII ¼ radiologically rGBM on progression but unverified on biopsy). Changes in neurological status and performance status recorded prospectively in 35
Fig 1. Bar charts for individual patients indicating the number of week of chemotherapy exposure (blue). The number of weeks of change in neurological status (red) indicating: up e improvement; down e deterioration; not indicated e no change. http://dx.doi.org/10.1016/j.clon.2015.01.003 0936-6555/Ó 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Dixit S, Hingorani M, Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma, Clinical Oncology (2015), http://dx.doi.org/10.1016/j.clon.2015.01.003
2
Letter / Clinical Oncology xxx (2015) 1e2
patients (rGBM: 30; rGIII: 5) receiving bevacizumab were compared with those of 40 patients studied retrospectively (rGBM: 32; rGIII: 8) who received PCV since temozolomide became standard of care for de novo GBM at our centre. The progression was decided in multidisciplinary team meetings based on the relevant clinical and radiological findings. This decision making process remained unchanged over the period of use of these two regimens. The demographics and other characteristics were not significantly different. Analysing all the patients (rGMB and rGIII), PFS-6 was significantly better in the bevacizumab group than in the PCV group (38% versus 15%, P ¼ 0.0045), but in the rGBM subgroup it was 31% versus 19% (P ¼ 0.08) in the bevacizumab and PCV groups, respectively. The mean chemotherapy exposure was 25 weeks (median 20) and 12 weeks (median 9.5) in the bevacizumab and PCV groups, respectively. Changes in neurological status indicated significant advantage in the bevacizumab group (Figure 1). The changes in the neurological status reflected in changes in the performance status d improvement in the bevacizumab group and deterioration in the PCV group (Table 1). Acknowledging the limitations of comparing prospective data with retrospective data, compared with PCV, marked neurological and performance status improvement observed with bevacizumab indicate that its quality of life changing benefit in some patients with rGBM may not be ignored.
Table 1 Changes in the performance state in the two groups Performance status
Bevacizumab
PCV
Before
During
Before
During
0 1 2 3
nil 19 (54%) 14 (40%) 02 (06%)
8 (23%) 18 (51%) 07 (20%) 02 (6%)
1 30 (75%) 09 (22.5%) nil
2 21 (52.5%) 13 (32.5%) 04 (10%)
Bevacizumab group: Wilcoxon signed-rank test P ¼ 0.013 (sum of positive rank ¼ 203; sum of negative rank ¼ 50). PCV group: Wilcoxon signed-rank test P ¼ 0.0232 (sum of positive rank ¼ 10; sum of negative rank ¼ 68). S. Dixit, M. Hingorani Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
References [1] http://www.ema.europa.eu/pdfs/human/opinion/Avastin_ Q&A_74620809en.pdf. EMEA. Questions and answers on the recommendation for the refusal of a change to themarketing authorisation for AvastinÒ. Press release. 2009. [2] Wick W, Weller M, van den Bent M, Stupp R. Bevacizumab and recurrent malignant gliomas: a European perspective. J Clin Oncol 2010;28:e188ee189.
Please cite this article in press as: Dixit S, Hingorani M, Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma, Clinical Oncology (2015), http://dx.doi.org/10.1016/j.clon.2015.01.003
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letter
Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma Sir e The role of bevacizumab in patients with recurrent glioblastoma (rGBM) remains controversial [1]. Although often used in many European countries [2], its efficacy has not been compared with a combination of procarbazine, lomustine and, vincristine (PCV), a commonly used
chemotherapy regimen in this setting in the UK. We present outcomes comparing these agents in rGBM and recurrent grade III tumour (rGIII ¼ radiologically rGBM on progression but unverified on biopsy). Changes in neurological status and performance status recorded prospectively in 35
Fig 1. Bar charts for individual patients indicating the number of week of chemotherapy exposure (blue). The number of weeks of change in neurological status (red) indicating: up e improvement; down e deterioration; not indicated e no change. http://dx.doi.org/10.1016/j.clon.2015.01.003 0936-6555/Ó 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Dixit S, Hingorani M, Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma, Clinical Oncology (2015), http://dx.doi.org/10.1016/j.clon.2015.01.003
2
Letter / Clinical Oncology xxx (2015) 1e2
patients (rGBM: 30; rGIII: 5) receiving bevacizumab were compared with those of 40 patients studied retrospectively (rGBM: 32; rGIII: 8) who received PCV since temozolomide became standard of care for de novo GBM at our centre. The progression was decided in multidisciplinary team meetings based on the relevant clinical and radiological findings. This decision making process remained unchanged over the period of use of these two regimens. The demographics and other characteristics were not significantly different. Analysing all the patients (rGMB and rGIII), PFS-6 was significantly better in the bevacizumab group than in the PCV group (38% versus 15%, P ¼ 0.0045), but in the rGBM subgroup it was 31% versus 19% (P ¼ 0.08) in the bevacizumab and PCV groups, respectively. The mean chemotherapy exposure was 25 weeks (median 20) and 12 weeks (median 9.5) in the bevacizumab and PCV groups, respectively. Changes in neurological status indicated significant advantage in the bevacizumab group (Figure 1). The changes in the neurological status reflected in changes in the performance status d improvement in the bevacizumab group and deterioration in the PCV group (Table 1). Acknowledging the limitations of comparing prospective data with retrospective data, compared with PCV, marked neurological and performance status improvement observed with bevacizumab indicate that its quality of life changing benefit in some patients with rGBM may not be ignored.
Table 1 Changes in the performance state in the two groups Performance status
Bevacizumab
PCV
Before
During
Before
During
0 1 2 3
nil 19 (54%) 14 (40%) 02 (06%)
8 (23%) 18 (51%) 07 (20%) 02 (6%)
1 30 (75%) 09 (22.5%) nil
2 21 (52.5%) 13 (32.5%) 04 (10%)
Bevacizumab group: Wilcoxon signed-rank test P ¼ 0.013 (sum of positive rank ¼ 203; sum of negative rank ¼ 50). PCV group: Wilcoxon signed-rank test P ¼ 0.0232 (sum of positive rank ¼ 10; sum of negative rank ¼ 68). S. Dixit, M. Hingorani Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
References [1] http://www.ema.europa.eu/pdfs/human/opinion/Avastin_ Q&A_74620809en.pdf. EMEA. Questions and answers on the recommendation for the refusal of a change to themarketing authorisation for AvastinÒ. Press release. 2009. [2] Wick W, Weller M, van den Bent M, Stupp R. Bevacizumab and recurrent malignant gliomas: a European perspective. J Clin Oncol 2010;28:e188ee189.
Please cite this article in press as: Dixit S, Hingorani M, Comparative Efficacy of Bevacizumab and PCV Chemotherapy in Recurrent Glioblastoma, Clinical Oncology (2015), http://dx.doi.org/10.1016/j.clon.2015.01.003