Retrospective Analysis of Bevacizumab in Combination With Ifosfamide, Carboplatin, and Etoposide in Patients With Second Recurrence of Glioblastoma

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  • ARAKAWA Yoshiki
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • MIZOWAKI Takashi
    Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine
  • MURATA Daiki
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • FUJIMOTO Koichi
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • KIKUCHI Takayuki
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • KUNIEDA Takeharu
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • TAKAHASHI Jun C.
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • TAKAGI Yasushi
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • MIYAMOTO Susumu
    Department of Neurosurgery, Kyoto University Graduate School of Medicine

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Abstract

Bevacizumab has been reported to be effective for recurrent glioblastoma. In our hospital, ifosfamide, carboplatin, etoposide (ICE) is the second-line chemotherapy for first recurrence of glioblastoma after temozolomide failure. In the present analysis, we retrospectively investigated the feasibility and effectiveness of bevacizumab combined with ICE in patients with glioblastoma at second relapse during ICE treatment. Between 2010 and 2012, tumor progressions were diagnosed in consecutive 8 patients who were treated with ICE for the first recurrence of glioblastoma. These patients were administered 3 cycles of 10 mg/kg bevacizumab every two weeks in combination with ICE treatment. The objective response rate of bevacizumab combination was 75% in Neuro-Oncology Working Group (RANO criteria), including complete response and partial response. Median progression free survival (PFS) and median overall survival (OS) after second relapse were 3.7 months (95% confidence interval [CI], 2.5–18.5 months) and 6.0 months (95% CI, 3.2–19.7 months), respectively. The 6-month PFS rates were 25% (95% CI, 0–55.0%). The median OS after initial diagnosis was 23.3 months (95% CI, 16.2–55.8 months). The grade 2 or 3 hematologic adverse events were identified in 7 of 8 patients, most of which might be due to ICE chemotherapy. The results of our retrospective analysis suggest that combination treatment with bevacizumab and ICE may be safe and beneficial in patients with recurrent glioblastoma.

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