Tipping Matthew, Eickhoff Jens, Ian Robins H
Department of Medicine University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, United States.
Department of Biostatistics and Medical Informatics, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin Carbone Cancer Center, UWSMPH, United States.
J Clin Neurosci. 2017 Oct;44:101-106. doi: 10.1016/j.jocn.2017.06.070. Epub 2017 Jul 12.
Bevacizumab (BEV) is a common treatment for recurrent glioblastoma (GBM). After progression on BEV, there is no consensus on subsequent therapy, as multiple chemotherapy trials have failed to demonstrate discernible activity for salvage. A previous review (995 patients) estimated a progression free survival (PFS) on BEV of 4.2months (SD±2.1) with an overall survival (OS) after progression on BEV at 3.8months (SD±1). We endeavored to establish a more rigorous historical control, both as a benchmark for efficacy, and a prognostic tool for clinical practice. A comprehensive literature review was performed utilizing PubMed and societal presentation abstracts. A total 2388 patients from 53 arms of 42 studies were analyzed in three groups: 1) thirty-two studies in which survival post-BEV was determined by subtracting PFS from OS (2045 patients): PFS on BEV=4.38months (95% CI 4.09-4.68); OS post-BEV=3.36months (95% CI 3.12-3.66); 2) two studies (94 patients) in which OS post-BEV is reported: OS=3.26 (95% CI 2.39-4.42); 3) eight studies of salvage therapy after progression on BEV (249 patients): of OS post-BEV=4.46months (95% CI 3.68-5.54). These estimates provide a firm historical control for PFS on BEV, as well as OS after disease progression on BEV therapy.
贝伐单抗（BEV）是复发性胶质母细胞瘤（GBM）的常用治疗方法。在接受BEV治疗病情进展后，后续治疗尚无共识，因为多项化疗试验未能证明其在挽救治疗中的明显活性。先前一项综述（995例患者）估计，BEV治疗的无进展生存期（PFS）为4.2个月（标准差±2.1），BEV治疗病情进展后的总生存期（OS）为3.8个月（标准差±1）。我们致力于建立一个更严格的历史对照，既作为疗效的基准，也作为临床实践的预后工具。利用PubMed和学术会议报告摘要进行了全面的文献综述。对来自42项研究53个组的总共2388例患者进行了三组分析：1）32项研究，其中BEV治疗后的生存期通过从OS中减去PFS来确定（2045例患者）：BEV治疗的PFS = 4.38个月（95%置信区间4.09 - 4.68）；BEV治疗后的OS = 3.36个月（95%置信区间3.12 - 3.66）；2）两项研究（94例患者）报告了BEV治疗后的OS：OS = 3.26（95%置信区间2.39 - 4.42）；3）八项关于BEV治疗病情进展后挽救治疗的研究（249例患者）：BEV治疗后的OS = 4.46个月（95%置信区间3.68 - 5.54）。这些估计为BEV治疗的PFS以及BEV治疗疾病进展后的OS提供了可靠的历史对照。
