Nghiemphu P L, Liu W, Lee Y, Than T, Graham C, Lai A, Green R M, Pope W B, Liau L M, Mischel P S, Nelson S F, Elashoff R, Cloughesy T F
Department of Neurology, Jonsson Comprehensive Cancer Center, University of California at Los Angeles and David Geffen School of Medicine, Los Angeles, CA 90095, USA.
Neurology. 2009 Apr 7;72(14):1217-22. doi: 10.1212/01.wnl.0000345668.03039.90.
Bevacizumab has been shown to be effective in the treatment of recurrent glioblastoma in combination with chemotherapy compared with historic controls but not in randomized trials.
We conducted a retrospective analysis of patients treated for recurrent glioblastoma with bevacizumab vs a control group of patients, comparing progression-free survival (PFS) and overall survival (OS) between the two groups, and performed subgroup analysis based on age and performance status. Expression of vascular endothelial growth factor (VEGF) based on age was examined using DNA microarray analysis. We also evaluated the impact of bevacizumab on quality of life.
We identified 44 patients who received bevacizumab and 79 patients who had not been treated with bevacizumab. There was a significant improvement in PFS and OS in the bevacizumab-treated group. Patients of older age (> or =55 years) and poor performance status (Karnofsky Performance Status < or =80) had significantly better PFS when treated with bevacizumab, and bevacizumab-treated older patients had significantly increased OS. VEGF expression was significantly higher in older glioblastoma patients (aged > or =55 years). Patients treated with bevacizumab also required less dexamethasone use and maintained their functional status longer than the control group.
Bevacizumab in combination with chemotherapy may be a more effective treatment for recurrent glioblastoma and warrants further randomized prospective studies to determine its effect on survival. Bevacizumab also has more effect in those with older age and might reflect biologic differences in glioblastoma in different age groups as seen with the expression of vascular endothelial growth factor.
与历史对照相比，贝伐单抗联合化疗已显示出对复发性胶质母细胞瘤有效，但在随机试验中并非如此。
我们对接受贝伐单抗治疗的复发性胶质母细胞瘤患者与对照组患者进行了回顾性分析，比较两组之间的无进展生存期（PFS）和总生存期（OS），并根据年龄和体能状态进行亚组分析。使用DNA微阵列分析检查基于年龄的血管内皮生长因子（VEGF）表达。我们还评估了贝伐单抗对生活质量的影响。
我们确定了44例接受贝伐单抗治疗的患者和79例未接受贝伐单抗治疗的患者。贝伐单抗治疗组的PFS和OS有显著改善。年龄较大（≥55岁）且体能状态较差（卡诺夫斯基体能状态≤80）的患者在接受贝伐单抗治疗时PFS显著更好，且接受贝伐单抗治疗的老年患者OS显著延长。老年胶质母细胞瘤患者（年龄≥55岁）的VEGF表达显著更高。与对照组相比，接受贝伐单抗治疗的患者使用地塞米松的量更少，且功能状态维持时间更长。
贝伐单抗联合化疗可能是复发性胶质母细胞瘤更有效的治疗方法，值得进一步进行随机前瞻性研究以确定其对生存的影响。贝伐单抗对年龄较大者也有更大效果，这可能反映了不同年龄组胶质母细胞瘤的生物学差异，如血管内皮生长因子的表达情况所示。
