Diaz Roberto Jose, Ali Sheikh, Qadir Mehreen Gull, De La Fuente Macarena I, Ivan Michael E, Komotar Ricardo J
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue University, Montreal, H3A 2B4, QC, Canada.
College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
J Neurooncol. 2017 Jul;133(3):455-467. doi: 10.1007/s11060-017-2477-x. Epub 2017 May 19.
Bevacizumab has been used in patients with GBM as a salvage therapy since its approval in the United States for recurrent GBM in 2009. In order to review the therapeutic effect of bevacizumab in the primary and recurrent clinical setting we have performed a systematic analysis of data from the published literature. Weighted median progression free survival and overall survival were calculated and compared to standard therapy or other experimental therapies. A qualitative analysis of the limited studies on health related quality of life and effects on steroid requirements was also undertaken. We found that the available literature supports the use of bevacizumab for prolonging PFS and OS in the recurrent setting either alone or in combination with a cytotoxic agent (P < 0.05), but does not support its use in the primary setting (P > 0.05). The survival advantage of bevacizumab compared to experimental therapy at recurrence is limited to 4 months. There is no additional benefit reported to date in health-related quality of life with the use of bevacizumab, although it may reduce steroid requirements. On average there is one side-effect event per patient and 74% of these events are grade 3 toxicity or higher. Further studies investigating the role of bevacizumab in combination with cytotoxic agents at recurrence are awaited.
自2009年贝伐单抗在美国被批准用于复发性胶质母细胞瘤（GBM）以来，它一直被用作GBM患者的挽救治疗。为了评估贝伐单抗在初治和复发临床环境中的治疗效果，我们对已发表文献中的数据进行了系统分析。计算了加权中位无进展生存期和总生存期，并与标准治疗或其他实验性治疗进行比较。还对关于健康相关生活质量和对类固醇需求影响的有限研究进行了定性分析。我们发现，现有文献支持在复发情况下单独或与细胞毒性药物联合使用贝伐单抗来延长无进展生存期（PFS）和总生存期（OS）（P<0.05），但不支持在初治情况下使用（P>0.05）。与复发时的实验性治疗相比，贝伐单抗的生存优势仅限于4个月。尽管使用贝伐单抗可能会减少类固醇需求，但迄今为止在健康相关生活质量方面未报告有额外益处。平均每位患者有一次副作用事件，其中74%的事件为3级或更高级别的毒性反应。期待进一步研究贝伐单抗在复发时与细胞毒性药物联合使用的作用。
