www.hirntumorhilfe.de
Herzlich willkommen im Forum der Deutschen Hirntumorhilfe!

Thema: News: Keinen Vorteil durch zusätzliches Bevacizumab

News: Keinen Vorteil durch zusätzliches Bevacizumab
Neon
02.12.2017 22:56:22
Lomustine and Bevacizumab in Progressive Glioblastoma

The New England Journal of Medicine, N. Engl. J. Med 2017 Nov 16;377(20)1954-1963,

W Wick, T Gorlia, M Bendszus, M Taphoorn, F Sahm, I Harting, AA Brandes, W Taal, J Domont, A Idbaih, M Campone, PM Clement, R Stupp, M Fabbro, E Le Rhun, F Dubois, M Weller, A von Deimling, V Golfinopoulos, JC Bromberg, M Platten, M Klein, MJ van den Bent

Bevacizumab is approved for the treatment of patients with progressive glioblastoma on the basis of uncontrolled data. Data from a phase 2 trial suggested that the addition of bevacizumab to lomustine might improve overall survival as compared with monotherapies. We sought to determine whether the combination would result in longer overall survival than lomustine alone among patients at first progression of glioblastoma.

Methods: We randomly assigned patients with progression after chemoradiation in a 2:1 ratio to receive lomustine plus bevacizumab (combination group, 288 patients) or lomustine alone (monotherapy group, 149 patients). The methylation status of the promoter of O(6)-methylguanine-DNA methyltransferase (MGMT) was assessed. Health-related quality of life and neurocognitive function were evaluated at baseline and every 12 weeks. The primary end point of the trial was overall survival.

Results: A total of 437 patients underwent randomization. The median number of 6-week treatment cycles was three in the combination group and one in the monotherapy group. With 329 overall survival events (75.3%), the combination therapy did not provide a survival advantage; the median overall survival was 9.1 months (95% confidence interval [CI], 8.1 to 10.1) in the combination group and 8.6 months (95% CI, 7.6 to 10.4) in the monotherapy group (hazard ratio for death, 0.95; 95% CI, 0.74 to 1.21; P=0.65). Locally assessed progression-free survival was 2.7 months longer in the combination group than in the monotherapy group: 4.2 months versus 1.5 months (hazard ratio for disease progression or death, 0.49; 95% CI, 0.39 to 0.61; P<0.001). Grade 3 to 5 adverse events occurred in 63.6% of the patients in the combination group and 38.1% of the patients in the monotherapy group. The addition of bevacizumab to lomustine affected neither health-related quality of life nor neurocognitive function. The MGMT status was prognostic.

Conclusions: Despite somewhat prolonged progression-free survival, treatment with lomustine plus bevacizumab did not confer a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma.


TAKE-HOME MESSAGE

This study randomized 437 patients with progressive glioblastoma after chemoradiation in a 2:1 fashion to receive either lomustine plus bevacizumab or lomustine alone. With 329 OS events (75.3%), the combination therapy did not provide a survival advantage; the median OS was 9.1 months in the combination group and 8.6 months in the monotherapy group. Locally assessed PFS was 2.7 months longer in the combination group than in the monotherapy group (4.2 months vs 1.5 months; HR for disease progression or death, 0.49).

Although PFS was somewhat prolonged, treatment with lomustine plus bevacizumab did not translate to a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma.

– Jeffrey Wiisanen, MD


"Es ist wahrscheinlich, dass Bevacizumab die Symptome in erster Linie dadurch verbessert, dass die vaskuläre Permeabilität reduziert wird, was zu einer Verringerung des Hirnödems führt", aber keinen Effekt auf das Gesamtüberleben.
Neon
Smarty66
02.12.2017 23:51:05
Ich würde mich über eine deutsche Übersetzung freuen. Ich bin sicher, daß ich nicht die einzige bin, die das wissen möchte. Schwierig alles treffend zu übersetzen ☺

**************************************************************************
7/14 Diagnose Glioblastom 7/14 links frontal / inoperabel.
Seit 14.9.17 neue Diagnose: Anaplastisches Oligogendrogliom WHO III.
Smarty66
Logossos
03.12.2017 11:59:28
Die Ergebnisse wurden bereits vor zwei Jahren auf der SNO-Konferenz 2015 vorgetragen:
http://www.cancernetwork.com/sno-2015/lomustinebevacizumab-fails-improve-survival-recurrent-glioblastoma
Das Ergebnis in Kürze:
Die Kombination von Avastin (Bevacizumab) und CCNU (Lomustin) verlängert nicht das Gesamtüberleben (Overall Survival OS) bei einem erstmals auftretenden GBM-Rezidiv im Vergleich zur alleinigen Anwendung von CCNU.
Logossos
Smarty66
03.12.2017 12:25:47
@ Logossos
Dankeschön für deine Info :)
Smarty66
NACH OBEN