Temozolomide plus bevacizumab may benefit elderly patients with glioblastoma with a low Karnofsky performance score (KPS), according to research published in The Oncologist.1
About 45% of patients with glioblastoma are older than 65 years, and there is no standard treatment for patients older than 70 years with a KPS lower than 70. Preclinical evidence suggested that temozolomide with bevacizumab might improve clinical outcomes and quality of life in this patient population.
For this non-randomized phase 2 trial (ClinicalTrials.gov Identifier: NCT02898012), researchers enrolled 66 patients with glioblastoma to evaluate the safety and efficacy of upfront temozolomide with bevacizumab.
The median patient age was 76 years; the median KPS was 60. Patients received temozolomide (130-150 mg/m2 daily) for 5 days every 4 weeks and bevacizumab (10 mg/kg) every 2 weeks.
About one-third of patients had an objective response. The median progression-free survival was 15.3 weeks and the median overall survival (OS) was 23.9 weeks, which was nearly twice the authors’ unpublished data showing an expectancy of 12 weeks with supportive care alone.
Quality of life and cognition, furthermore, improved during treatment: 33% of patients became transiently capable of self-care with KPS scores over 70.
The most common grade 3 or worse adverse events were hematologic (20%), high blood pressure (24%), venous thromboembolism (4.5%), cerebral hemorrhage (3%), and intestinal perforation (3%).
The authors concluded that “the estimated OS median of 24 weeks that we found appears higher that the 12 weeks of OS that we found in a similar patient population treated with supportive care alone (personal data, unpublished). However, it is comparable to the 25 weeks that we reported in similar patients receiving [temozolomide] alone. Whether this combination is superior to [temozolomide] alone remains to be demonstrated by a randomized study.”
- Reyes‐Botero G, Cartalat‐Carel S, Chinot OL, et al. Temozolomide plus bevacizumab in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial (ATAG). Oncologist. 2018 Feb 22. doi: 10.1634/theoncologist.2017-0689 [Epub ahead of print]