A large study of patients with newly diagnosed glioblastoma multiforme suggests that the addition of bevacizumab (Avastin) and irinotecan (Camptosar) to standard chemoradiation can extend survival (progression and overall survival) by 6 months.
Bevacizumab (Avastin) is an inhibitor of vascular endothelial growth factor and irinotecan (Camptosar) is a topoisomerase inhibitor that prevents DNA replication. Chemoradiation refers to temozolomide (Temodar)-based chemotherapy and radiation.
The study included 125 patients who have new diagnosed grade 4 malignant glioblastoma multiforme. Patients were treated in 2 phases.
In the first phase, two to 4 weeks after surgical resection, patients received 6 weeks of radiation, daily temozolomide 75 mg/m2 and bevacizumab 10 mg/kg once every 2 weeks,
In the second phase, patients received 6 to 12 more weeks of bevacizumab, combined with temozolomide at 200 mg/m2 on days 1 to 5 of each month, plus irinotecan, dosed according to whether patients were or were not taking enzyme-inducing antiepileptic drugs (340 mg/m2 or 125 mg/m2, respectively, on days 1 and 15 of each month).
The final analysis showed a median progression-free survival of 14.2 months and a median overall survival of 21.3 months in patients treated with the new regimen. This survival data compared favorably to progression-free survival of 6.9 months and overall survival of 15.9 months reported in the literature.
Serious toxicities associated with bevacizumab and irinotecan included CNS hemorrhage, venous thromboembolisms, wound dehiscences, bowel perforation, grade 4 hematologic toxicities, secondary malignancy, and pneumocystis pneumonias.
While the study showed promise with the new regimen, a double-blind, head-to-head study against standard regimen is required to confirm the ultimate role of bevacizumab and irinotecan in the treatment of glioblastoma.
Source: Society for Neuro-Oncology 15th Annual Scientific Meeting: Abstract OT-34. Presented in November 21, 2010.
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