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Treatment With Bevacizumab Plus Carboplatin for Recurrent Malignant Glioma

Thompson, Eric M. MD; Dosa, Edit MD; Kraemer, Dale F. PhD; Neuwelt, Edward A. MD

doi: 10.1227/01.NEU.0000370918.51053.BC
Clinical Studies

OBJECTIVE: To estimate overall survival (OS), progression-free survival (PFS), imaging responses, and toxicities of bevacizumab plus carboplatin for the treatment of recurrent malignant glioma. The secondary objective was to estimate the agreement between postcontrast T1-weighted and T2-weighted magnetic resonance imaging.

METHODS: A retrospective analysis of 9 patients who received bevacizumab (10 mg/kg intravenously) and carboplatin (AUC 5 intravenously) for recurrent malignant glioma (World Health Organization grades III and IV) is presented. Eight of 9 patients received this regimen at first recurrence.

RESULTS: The median age and Karnofsky performance score were 51 years and 70, respectively. For the 5 patients with grade III gliomas, the median PFS was 126 days, whereas median OS was not attained at 517 days of follow-up. Six-month PFS was 40%, whereas 6-month OS was 60%. For the 4 patients with grade IV gliomas, the median PFS was 216 days, whereas the median OS was not attained at 482 days of follow-up. Six-month PFS was 50%, whereas 6-month OS was 75%. The agreement between contrast-enhanced T1-weighted and T2-weighted images to determine recurrence was moderate (kappa = 0.5714). Three patients had grade 3 and 4 toxicities including hyponatremia and thrombocytopenia.

CONCLUSION: Patients who received the combination of bevacizumab plus carboplatin for recurrent malignant glioma had reasonable PFS, OS, and toxicities. The median OS in our series is promising at well over 1 year. Agreement between postcontrast T1- and T2-weighted images is only moderate in the context of bevacizumab therapy.

Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon (Thompson)

Department of Neurology, Oregon Health & Science University, Portland, Oregon (Dosa)

Department of Pharmacy Practice, Oregon Health & Science University College of Pharmacy, Oregon State University, Department of Medical Informatics, Clinical Epidemiology, and Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon (Kraemer)

Departments of Neurological Surgery and Neurology, Oregon Health & Science University, Portland Veterans Affairs Medical Center, Portland, Oregon (Neuwelt)

Reprint requests: Edward A. Neuwelt, MD, Department of Neurology, Blood-Brain Barrier Program, Oregon Health and Sciences University, 3181 Sam Jackson Parkway Road, L603, Portland, OR 97239. E-mail: neuwelte@ohsu.edu

Received, March 26, 2009.

Accepted, November 28, 2009.

Copyright © by the Congress of Neurological Surgeons