Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
J Neurooncol. 2020 Jun;148(2):373-379. doi: 10.1007/s11060-020-03533-5. Epub 2020 May 14.
Despite a large number of trials, the role of bevacizumab (BEV) in the treatment of recurrent high-grade gliomas is still controversial. Evidence regarding an effect on overall survival in this context is ultimately inconclusive. At the Department of Radiation Oncology at Erlangen, Germany we treated a large cohort of patients with recurrent gliomas where bevacizumab use was determined exclusively by the health care provider's approval of reimbursement.
61 patients (between 06/2008 and 01/2014) with recurrent high-grade gliomas had reimbursement requests for BEV sent to their health insurance. 37 patients out of 61 (60.7%) had their requests approved and therefore received bevacizumab (BEV-arm) as part of their treatment. The remaining 24 (39.3%) patients received standard therapy without bevacizumab (non-BEV-arm). Survival endpoints were defined with reference to the first BEV request to the health insurance provider.
Median overall survival (OS) for the whole cohort was 7.0 months. OS was significantly better for BEV vs. Non-BEV patients (median, 10.3 vs. 4.2 months, logrank p = 0.023). There was an increased BEV benefit in cases of higher-order recurrences (first order recurrence BEV vs. Non-BEV, 12.5 vs. 10.2 months, p = 0.578) (second or higher order of recurrence, 9.9 vs. 2.6 months, p = 0.010). On multivariate analysis for overall survival the prognostic impact of bevacizumab (HR = 0.43, p = 0.034) remained significant.
Our results suggest an influence of BEV on overall survival in a heavily pretreated patient population suffering from high-grade gliomas with BEV benefit being greatest in case of second or later recurrence.
尽管进行了大量试验，但贝伐珠单抗（bevacizumab，BEV）在复发性高级别脑胶质瘤治疗中的作用仍存在争议。在这种情况下，关于总生存的证据最终尚无定论。在德国埃尔朗根的放射肿瘤学系，我们治疗了大量复发性脑胶质瘤患者，BEV 的使用完全由医疗保健提供者对报销的批准决定。
61 名（2008 年 6 月至 2014 年 1 月）复发性高级别脑胶质瘤患者向其健康保险公司提交了贝伐珠单抗的报销申请。在 61 名患者中，有 37 名（60.7%）的申请获得批准，因此作为治疗的一部分接受了贝伐珠单抗（BEV 组）。其余 24 名（39.3%）患者接受了无贝伐珠单抗的标准治疗（非 BEV 组）。生存终点根据向健康保险公司提出的第一次 BEV 请求来定义。
全队列的中位总生存期（overall survival，OS）为 7.0 个月。BEV 组与非 BEV 组的 OS 显著更好（中位 OS，10.3 个月与 4.2 个月，对数秩检验 p=0.023）。在更高阶复发的情况下，BEV 的获益增加（一阶复发 BEV 与非 BEV，12.5 个月与 10.2 个月，p=0.578）（二阶或更高阶复发，9.9 个月与 2.6 个月，p=0.010）。多变量分析显示，OS 的总体预后因素中，贝伐珠单抗的影响（风险比[HR]=0.43，p=0.034）仍然显著。
我们的结果表明，在复发性高级别脑胶质瘤的高度预处理患者人群中，贝伐珠单抗对总生存有影响，并且在二阶或更高阶复发的情况下，贝伐珠单抗的获益最大。
