Mamo A, Baig A, Azam M, Rho Y S, Sahebjam S, Muanza T, Owen S, Petrecca K, Guiot M C, Al-Shami J, Sharma R, Kavan P
Segal Cancer Centre, Jew ish General Hospital, McGill University, Montreal, QC.
Radiation Oncology, Jewish General Hospital, McGill University Health Centre, Montreal, QC.
Curr Oncol. 2016 Oct;23(5):e468-e471. doi: 10.3747/co.23.3108. Epub 2016 Oct 25.
The use of bevacizumab in the management of glioblastoma multiforme (gbm) remains controversial. In Canada, bevacizumab is approved for the treatment of recurrent gbm. We describe a pattern of progression across treatment lines in gbm.
During 2008-2014, 64 patients diagnosed with gbm were treated with bevacizumab at McGill University hospitals. Of those patients, 30 (46.9%) received bevacizumab in the first line (B1L), and 34 (53.1%) received it in the second line and beyond (B2L+). The average length of treatment with bevacizumab was 24.4 weeks (range: 0-232.7 weeks). The patterns of progression were categorized as local, distant, diffuse, multifocal, or multi-pattern.
Local progression was seen in 46.7% of B1L patients and 26.5% of B2L+ patients, distant in 3.3% and 2.9%, diffuse in 20% and 47%, multifocal in 10% and 8.8%, and multi-pattern in 3.3% and 11.8%. No differences between the groups were observed for the distant ( = 0.3) or diffuse ( = 0.4) patterns. Grades 3 and 4 adverse events in the B1L and B2L+ groups were fatigue (33.3% vs. 17.6% respectively), hypertension (26.7% vs. 5.9%), thrombocytopenia (26.7% vs. 11.8%), neutropenia (26.7% vs. 11.8%), anemia (23.3% vs. 11.8%), leucopenia (20% vs. 8.8%), deep vein thrombosis (23.3% vs. 5.9%), seizure (16.7% vs. 8.8%), brain hemorrhage (6.7% vs. <1%), and delayed wound healing (6.7% vs. 2.9%). More total grades 3 and 4 adverse events occurred in the B1L group ( = 0.000519).
In our cohort, patterns of progression were not different in B1L and B2L+ patients. Moreover, both groups experienced similar adverse events, although more grades 3 and 4 events occurred in the B1L group, implying that severe adverse events in B1L patients could negatively affect survival outcomes.
贝伐单抗在多形性胶质母细胞瘤（GBM）治疗中的应用仍存在争议。在加拿大，贝伐单抗被批准用于复发性GBM的治疗。我们描述了GBM患者跨治疗线的进展模式。
2008年至2014年期间，麦吉尔大学医院对64例诊断为GBM的患者使用了贝伐单抗进行治疗。在这些患者中，30例（46.9%）一线接受贝伐单抗治疗（B1L），34例（53.1%）二线及以后接受治疗（B2L+）。贝伐单抗的平均治疗时长为24.4周（范围：0至232.7周）。进展模式分为局部、远处、弥漫、多灶或多模式。
B1L组患者中46.7%出现局部进展，B2L+组为26.5%；远处进展分别为3.3%和2.9%；弥漫性进展分别为20%和47%；多灶性进展分别为10%和8.8%；多模式进展分别为3.3%和11.8%。两组在远处（P = 0.3）或弥漫性（P = 0.4）进展模式上未观察到差异。B1L组和B2L+组3级和4级不良事件分别为疲劳（分别为33.3%和17.6%）、高血压（26.7%和5.9%）、血小板减少（26.7%和11.8%）、中性粒细胞减少（26.7%和11.8%）、贫血（23.3%和11.8%）、白细胞减少（20%和8.8%）、深静脉血栓形成（23.3%和5.9%）、癫痫发作（16.7%和8.8%）、脑出血（6.7%和<1%）以及伤口愈合延迟（6.7%和2.9%）。B1L组发生的3级和4级不良事件总数更多（P = 0.000519）。
在我们的队列中，B1L组和B2L+组患者的进展模式无差异。此外，两组经历的不良事件相似，尽管B1L组发生的3级和4级事件更多，这意味着B1L组患者的严重不良事件可能对生存结果产生负面影响。
