J Korean Med Sci.  2024 Sep;39(34):e244. 10.3346/jkms.2024.39.e244.

Bevacizumab Alone Versus Bevacizumab Plus Irinotecan in Patients With Recurrent Glioblastoma: A Nationwide Population-Based Study

• Lee Y
• Lee E
• Roh TH
• Kim SH

• KMID: 2559199
• DOI: http://doi.org/10.3346/jkms.2024.39.e244

Abstract

Background
For treating recurrent glioblastoma, for which there is no established treatment, the antiangiogenic antibody, bevacizumab, is used alone or with irinotecan. This study was aimed at comparing the survival of patients with recurrent glioblastoma receiving bevacizumab monotherapy and those receiving bevacizumab plus irinotecan combination therapy (B+I) by using a nationwide population-based dataset.
Methods
Patients matching the International Classification of Diseases code C71.x were screened from the Health Insurance Review and Assessment Service database. From January 2008 to November 2021, patients who underwent surgery or biopsy and subsequent standard concurrent chemoradiation with temozolomide were included. Among them, those who received bevacizumab monotherapy or B+I were selected. Demographic characteristics, inpatient stay, prescription frequency, survival outcomes, and steroid prescription duration were compared between these two groups.
Results
Eight hundred and forty-six patients who underwent surgery or biopsy and received concurrent chemoradiotherapy with temozolomide were included. Of these, 450 and 396 received bevacizumab monotherapy and B+I, respectively. The corresponding median overall survival from the initial surgery was 22.60 months (95% confidence interval [CI], 20.50– 24.21) and 20.44 months (95% CI, 18.55–22.60; P = 0.508, log-rank test). The B+I group had significantly more bevacizumab prescriptions (median 5 times; BEV group: median 3 times). Cox analysis, based on the postsurgery period, revealed that male sex (hazard ratio [HR], 1.28; P = 0.002), older age (HR, 1.01; P = 0.042), and undergoing biopsy instead of surgery (HR, 1.79; P < 0.0001) were significantly associated with decreased survival. Fewer radiotherapy cycles correlated with improved survival outcomes (HR, 0.63; P = 0.001). Cox analysis, conducted from the start of chemotherapy including bevacizumab, showed that male sex was the only variable significantly associated with decreased survival (HR, 1.18; P = 0.044).
Conclusion
We found no significant difference in overall survival between the bevacizumab monotherapy and B+I groups. Considering the additional potential toxicity associated with irinotecan, bevacizumab monotherapy could be a suitable treatment option for treating recurrent glioblastoma.

Keyword

Bevacizumab; Glioblastoma; Irinotecan; Survival Analysis; Chemoradiotherapy

Figure

• 

  Fig. 1 Flow chart of patient selection.CCRT = concurrent chemoradiation therapy, TMZ = temozolomide, HIRA = Health Insurance Review and Assessment Service, RT = radiation therapy, BEV = bevacizumab monotherapy, B+I = bevacizumab plus irinotecan combination therapy.

• 

  Fig. 2 Survival analysis according to chemotherapy regimen for recurrent glioblastomas. (A) Kaplan-Meier curves for survival duration from the time of surgery. (B) Kaplan-Meier curves for survival duration from the initiation of chemotherapy including bevacizumab.BEV = bevacizumab monotherapy, B+I = bevacizumab plus irinotecan combination therapy.

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