Liu Ping-Chuan, Kuo Chao-Yang, Chen Yi-Wei, Lin Chun-Fu, Lin Shih-Chieh, Chang Feng-Chi, Chen Ming-The, Wu Jau-Ching, Lee Yi-Yen
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Neurooncol Adv. 2025 Jul 18;7(1):vdaf157. doi: 10.1093/noajnl/vdaf157. eCollection 2025 Jan-Dec.
High-grade glioma (HGG) is an aggressive tumor for which there are no effective therapies at recurrence, especially for isocitrate dehydrogenase (IDH)-wild-type glioblastoma. This retrospective study compared survival outcomes between patients receiving bevacizumab alternating chemotherapy (BAC) and those receiving bevacizumab (BEV) alone.
We collected data from 95 adult patients with rHGG who were treated at our institute between January 2018 and August 2023. The patients were divided into 3 groups based on treatment and glioma grade: BAC regimen to treat grade 3 gliomas ( = 23), BAC regimen to treat grade 4 gliomas ( = 29), and treatment with BEV alone ( = 43). The BAC regimen included 2 cycles of etoposide + carboplatin, followed by 1 cycle of cyclophosphamide + vinblastine, with bevacizumab (10 mg/kg) every 4 weeks. One full cycle lasted approximately 3 months. We analyzed overall survival (OS) and postrecurrence survival (PRS).
In patients with grade 4 gliomas, the BAC regimen significantly improved survival compared with BEV alone, with a median OS of 29 versus 19 months and a PRS of 16 versus 10 months (both < .05). In the IDH-wild-type subgroup, the BAC regimen produced a median OS of 27 versus 19 months and a PRS of 16 versus 10 months ( < .05). The 2-year OS and PRS rates were also higher in the BAC groups. Notably, patients with MGMT-methylated grade 4 gliomas treated with the BAC regimen had the longest median OS, 33 months.
The BAC regimen appears effective and well tolerated in adult patients with rHGG, particularly in younger patients. Its alternating design may improve the median OS (29 vs. 19 months) and PRS (16 vs. 10 months) of patients with grade 4 gliomas while maintaining safety. As a practical option for those ineligible for clinical trials, BAC warrants further evaluation in prospective randomized studies to confirm its benefits and address the limitations of retrospective analysis.
高级别胶质瘤（HGG）是一种侵袭性肿瘤，复发时没有有效的治疗方法，尤其是对于异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤。这项回顾性研究比较了接受贝伐单抗交替化疗（BAC）的患者与仅接受贝伐单抗（BEV）的患者的生存结果。
我们收集了2018年1月至2023年8月在我院接受治疗的95例成年复发性HGG患者的数据。根据治疗方法和胶质瘤分级将患者分为3组：用于治疗3级胶质瘤的BAC方案（n = 23）、用于治疗4级胶质瘤的BAC方案（n = 29）和仅接受BEV治疗（n = 43）。BAC方案包括2个周期的依托泊苷+卡铂，随后是1个周期的环磷酰胺+长春花碱，每4周给予贝伐单抗（10mg/kg）。一个完整周期持续约3个月。我们分析了总生存期（OS）和复发后生存期（PRS）。
在4级胶质瘤患者中，与仅接受BEV相比，BAC方案显著提高了生存率，中位OS为29个月对
