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Single-agent Bevacizumab in Recurrent Glioblastoma After Second-line Chemotherapy With Fotemustine

The Experience of the Italian Association of Neuro-Oncology

Pasqualetti, Francesco, MD, PhD*; Pace, Andrea, MD; Gonnelli, Alessandra, MD*; Villani, Veronica, MD; Cantarella, Martina, MD*; Delishaj, Durim, MD*; Vivaldi, Caterina, MD; Molinari, Alessandro, MD*; Montrone, Sabrina, MD*; Pellerino, Alessia, MD§; Franchino, Federica, MD§; Baldaccini, Davide, MD*; Lombardi, Giuseppe, MD; Lolli, Ivan, MD; Catania, Francesca, MD#; Bazzoli, Elena, MD#; Morganti, Riccardo, MD**; Fabi, Alessandra, MD; Zagonel, Vittorina, MD; Bocci, Guido, MD, PhD††; Fabrini, Maria Grazia, MD*; Rudà, Roberta, MD§; Soffietti, Riccardo, MD§; Paiar, Fabiola, MD*

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1272–1275
doi: 10.1097/COC.0000000000000464
Original Articles: Central Nervous System

Objectives: Bevacizumab is an anti-vascular endothelial growth factor antibody used in the treatment of recurrent glioblastoma (GBM). Despite the large number of studies carried out in patients with recurrent GBM, little is known about the administration of this angiogenesis inhibitor after the failure of the second-line chemotherapy.

Materials and Methods: In this retrospective multicenter study, on behalf of the Italian Association of Neuro-Oncology, we reported the results obtained in 51 patients with recurrent GBM treated with single-agent bevacizumab after the failure of second-line chemotherapy with fotemustine.

Results: In March 2016, at the time of data analysis, 3 patients (14.4%) were still alive with stable disease, whereas 48 died due to disease progression. Kaplan-Meier estimated median survival from the diagnosis of GBM was 28 months (95% confidence interval [CI], 22.1-33.9 mo). Median survival measured from the beginning of fotemustine and bevacizumab therapy were 11.3 (95% CI, 8.4-13.6 mo) and 6 months (95% CI, 3.8-8.1 mo), respectively. The 6- and 12-month progression free survival rates from the beginning of bevacizumab treatment were 18% and 13%, respectively.

Conclusions: On the basis of our data, in patients with recurrent GBM, the failure of a second-line chemotherapy with cytotoxic agents might not exclude the administration of bevacizumab as third-line chemotherapy.

*Division of Radiation Oncology

**Department of Experimental and Clinical Medicine, Section of Statistics, Pisa University Hospital

Departments of Oncology, Division of Medical Oncology

††Clinical and Experimental Medicine, Division of Pharmacology, University of Pisa, Pisa

Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome

§Department of Neuro-Oncology, University of Turin and City of Health and Science, Turin

Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova

Medical Oncology, Saverio de Bellis IRCCS Hospital, Castellana Grotte

#Department of Neurology, University Hospital of Verona, Verona, Italy

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent for treatments was obtained from all individual participants included in the study.

The authors declare no conflicts of interest.

Reprints: Francesco Pasqualetti, MD, PhD, Department of Oncology, Division of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Via Roma 67, Pisa 56123, Italy. E-mails:,

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