Bevacizumab in recurrent WHO grades II-III glioma

Soufyan Annakib; Valérie Rigau; Amélie Darlix; Catherine Gozé; Hugues Duffau; Luc Bauchet; Marta Jarlier; Michel Fabbro

doi:10.3389/fonc.2023.1212714

Bevacizumab in recurrent WHO grades II-III glioma

Front Oncol. 2023 Jul 18:13:1212714. doi: 10.3389/fonc.2023.1212714. eCollection 2023.

Authors

Soufyan Annakib^{1

2}, Valérie Rigau^{3

4}, Amélie Darlix^{1

4}, Catherine Gozé^{3

4

5}, Hugues Duffau^{4

6}, Luc Bauchet^{4

6}, Marta Jarlier⁷, Michel Fabbro¹

Affiliations

¹ Department of Medical Oncology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France.
² Department of Medical Oncology, CHU de Nîmes, University of Montpellier, Nimes, France.
³ Department of Pathology and Onco-biology, CHU de Montpellier, University of Montpellier, Montpellier, France.
⁴ Institut de Génomique Fonctionnelle, INSERM, CNRS, University of Montpellier, Montpellier, France.
⁵ Faculty of Medicine, University of Montpellier, Montpellier, France.
⁶ Department of Neurosurgery, CHU de Montpellier, University of Montpellier, Montpellier, France.
⁷ Department of Biostatistics, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France.

Abstract

Purpose: 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.

Methods: 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.

Results: 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, p = 0.023 and 0.36, 95% CI 0.13-0.99, p = 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.

Conclusion: 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.

Keywords: anaplastic glioma; astrocytoma; bevacizumab; oligodendroglioma; recurrent glioma; transformed low grade glioma.