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J Neurooncol. 2018 Apr;137(2):439-446. doi: 10.1007/s11060-017-2736-x. Epub 2018 Jan 12.

Toxicity and efficacy of lomustine and bevacizumab in recurrent glioblastoma patients.

Author information

1
Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. jan.nyrop.jakobsen@regionh.dk.
2
Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
3
Department of Radiation Biology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
4
Department of Surgical Gastroenterology, Hvidovre Hospital, Kettegårds Alle 30, Hvidovre, Denmark.

Abstract

The combination of lomustine and bevacizumab is a commonly used salvage treatment for recurrent glioblastoma (GBM). We investigated the toxicity and efficacy of lomustine plus bevacizumab (lom-bev) in a community-based patient cohort and made a comparison to another frequently used combination therapy consisting of irinotecan plus bevacizumab (iri-bev). Seventy patients with recurrent GBM were treated with lomustine 90 mg/m2 every 6 weeks and bevacizumab 10 mg/kg every 2 weeks. Toxicity was registered and compared to the toxicity observed in 219 recurrent GBM patients who had previously been treated with irinotecan 125 mg/m2 and bevacizumab 10 mg/kg every 2 weeks. The response rate was 37.1% for lom-bev and 30.1% for iri-bev. Median progression-free survival (PFS) was 23 weeks for lom-bev and 21 weeks for iri-bev (p = 0.9). Overall survival (OS) was 37 weeks for lom-bev and 32 weeks for iri-bev (p = 0.5). Lom-bev caused a significantly higher frequency of thrombocytopenia (11.4% grade 3-4) compared to iri-bev (3.5% grade 3-4). Iri-bev patients had more gastrointestinal toxicity with regard to nausea, vomiting, diarrhea, constipation and stomatitis. Within the limitations of the study lom-bev is a well-tolerated treatment for recurrent GBM, although hematological toxicity may be a dose limiting factor. No significant differences between lom-bev and iri-bev were observed with regard to PFS or OS. The differences in toxicity profiles between lom-bev and iri-bev could guide treatment decision in recurrent GBM therapy as efficacy is equal and no predictive factors for efficacy exist.

KEYWORDS:

Bevacizumab; Chemotherapy; Glioblastoma; Irinotecan; Lonustine; Recurrent glioblastoma

PMID:
29330749
DOI:
10.1007/s11060-017-2736-x

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