Document Type
Article
Publication Date
2-20-2014
Abstract
BACKGROUND: Concurrent treatment with temozolomide and radiotherapy followed by maintenance temozolomide is the standard of care for patients with newly diagnosed glioblastoma. Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor A, is currently approved for recurrent glioblastoma. Whether the addition of bevacizumab would improve survival among patients with newly diagnosed glioblastoma is not known.
METHODS: In this randomized, double-blind, placebo-controlled trial, we treated adults who had centrally confirmed glioblastoma with radiotherapy (60 Gy) and daily temozolomide. Treatment with bevacizumab or placebo began during week 4 of radiotherapy and was continued for up to 12 cycles of maintenance chemotherapy. At disease progression, the assigned treatment was revealed, and bevacizumab therapy could be initiated or continued. The trial was designed to detect a 25% reduction in the risk of death and a 30% reduction in the risk of progression or death, the two coprimary end points, with the addition of bevacizumab.
RESULTS: A total of 978 patients were registered, and 637 underwent randomization. There was no significant difference in the duration of overall survival between the bevacizumab group and the placebo group (median, 15.7 and 16.1 months, respectively; hazard ratio for death in the bevacizumab group, 1.13). Progression-free survival was longer in the bevacizumab group (10.7 months vs. 7.3 months; hazard ratio for progression or death, 0.79). There were modest increases in rates of hypertension, thromboembolic events, intestinal perforation, and neutropenia in the bevacizumab group. Over time, an increased symptom burden, a worse quality of life, and a decline in neurocognitive function were more frequent in the bevacizumab group.
CONCLUSIONS: First-line use of bevacizumab did not improve overall survival in patients with newly diagnosed glioblastoma. Progression-free survival was prolonged but did not reach the prespecified improvement target. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00884741.).
Recommended Citation
Gilbert, Mark R; Dignam, James J; Armstrong, Terri S; Wefel, Jeffrey S; Blumenthal, Deborah T; Vogelbaum, Michael A; Colman, Howard; Chakravarti, Arnab; Pugh, Stephanie; Won, Minhee; Jeraj, Robert; Brown, Paul D; Jaeckle, Kurt A; Schiff, David; Stieber, Volker W; Brachman, David G; Werner-Wasik, Maria; Tremont-Lukats, Ivo W; Sulman, Erik P; Aldape, Kenneth D; Curran, Walter J; and Mehta, Minesh P, "A randomized trial of bevacizumab for newly diagnosed glioblastoma." (2014). Department of Radiation Oncology Faculty Papers. Paper 47.
https://jdc.jefferson.edu/radoncfp/47
PubMed ID
24552317
Comments
This article has been peer reviewed. It is the author’s final published version in New England Journal of Medicine Volume 370, Issue 8, February 2014, Pages 699-708.
The published version is available at DOI: 10.1056/NEJMoa1308573. Copyright © Massachusetts Medical Society