Annakib Soufyan, Rigau Valérie, Darlix Amélie, Gozé Catherine, Duffau Hugues, Bauchet Luc, Jarlier Marta, Fabbro Michel
Department of Medical Oncology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France.
Department of Medical Oncology, CHU de Nîmes, University of Montpellier, Nimes, France.
Front Oncol. 2023 Jul 18;13:1212714. doi: 10.3389/fonc.2023.1212714. eCollection 2023.
The management of recurrent WHO grades II-III (rGII-III) glioma is not well established. This study describes the clinical outcomes in patients who received bevacizumab as rescue treatment.
In this retrospective study, the main inclusion criteria were as follows: adult patients with histologicaly proved rGII-III glioma according 2016 WHO classification treated with bevacizumab from 2011 to 2019, T1 contrast enhancement on MRI. Efficacy was assessed using the high-grade glioma 2017 Response Assessment in Neuro-Oncology criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.
Eighty-one patients were included (M/F ratio: 1.7, median age at diagnosis: 38 years) among whom 46 (56.8%) had an initial diagnosis of grade II glioma. Previous treatments included at least one surgical intervention, radiotherapy (98.8%), and ≥ 2 chemotherapy lines (64.2%). After bevacizumab initiation, partial response, stable disease, and progressive disease were observed in 27.2%, 22.2%, and 50.6% of patients. The median PFS and OS were 4.9 months (95% confidence interval [CI] 3.7-6.1) and 7.6 months (95% CI 5.5-9.9). Bevacizumab severe toxicity occurred in 12.3%. Twenty-four (29.6%) patients discontinued bevacizumab without radiological progression. Oligodendroglioma and age ≥ 38 years at diagnosis were more frequent in this subgroup (odds ratio = 0.24, 95% CI 0.07-0.84, = 0.023 and 0.36, 95% CI 0.13-0.99, = 0.042). Ten of these 24 patients were alive at 12 months and two patients at 8 years after bevacizumab initiation, without any subsequent treatment.
Bevacizumab can be an option for heavily pretreated patients with rGII-III glioma with contrast enhancement. In our study, bevacizumab displayed prolonged activity in a subgroup of patients.
世界卫生组织（WHO）II - III级复发性（rGII - III）胶质瘤的管理方法尚未完全确立。本研究描述了接受贝伐单抗作为挽救治疗的患者的临床结局。
在这项回顾性研究中，主要纳入标准如下：2011年至2019年期间接受贝伐单抗治疗的、根据2016年WHO分类经组织学证实为rGII - III级胶质瘤的成年患者，MRI上有T1对比增强。使用2017年神经肿瘤学高级别胶质瘤反应评估标准评估疗效。采用Kaplan - Meier方法估计无进展生存期（PFS）和总生存期（OS）。
纳入81例患者（男/女比例：1.7，诊断时中位年龄：38岁），其中46例（56.8%）最初诊断为II级胶质瘤。既往治疗包括至少一次手术干预、放疗（98.8%）以及≥2线化疗（64.2%）。开始使用贝伐单抗后，27.2%、22.2%和50.6%的患者分别观察到部分缓解、疾病稳定和疾病进展。中位PFS和OS分别为4.9个月（95%置信区间[CI] 3.7 - 6.1）和7.6个月（95% CI 5.5 - 9.9）。贝伐单抗严重毒性发生率为12.3%。24例（29.6%）患者在无影像学进展的情况下停用贝伐单抗。该亚组中少突胶质细胞瘤和诊断时年龄≥38岁更为常见（优势比 = 0.24，95% CI 0.07 - 0.84，P = 0.023；以及0.36，95% CI 0.13 - 0.99，P = 0.042）。这24例患者中有10例在开始使用贝伐单抗后12个月时存活，2例在8年后存活，且未接受任何后续治疗。
对于经过大量治疗的有对比增强的rGII - III级胶质瘤患者，贝伐单抗可以作为一种选择。在我们的研究中，贝伐单抗在一部分患者中显示出延长的活性。
