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Corticosteroid use in patients with glioblastoma at first or second relapse treated with bevacizumab in the BRAIN study.

AbstractBACKGROUND:
Vascular endothelial growth factor inhibitors have corticosteroid-sparing effects in patients with high-grade gliomas. We assessed corticosteroid use in patients with recurrent glioblastoma treated with bevacizumab (BEV) in the BRAIN study (J Clin Oncol 2009;27:4733-4740).
METHODS:
BRAIN was a phase II, multicenter, randomized, noncomparative trial of BEV alone (n = 85) or in combination with irinotecan (CPT-11) (n = 82) in adults with recurrent glioblastoma. Median corticosteroid dose for patients who used corticosteroids at baseline was summarized by treatment arm; the percentage of patients who had sustained (≥50% corticosteroid dose reduction for ≥50% of time on study drug) or complete (discontinuation of corticosteroid for ≥25% of time on study drug) reduction in corticosteroid dose overall and by objective response and progression-free survival was calculated. The incidence of corticosteroid-related adverse events was summarized.
RESULTS:
In each treatment group, 50% of patients were using systemic corticosteroids at baseline. The majority of those experienced a reduction in dose while receiving BEV-based therapy. Thirteen (30.2%) BEV and 20 (46.5%) BEV + CPT-11 patients had a sustained reduction of corticosteroid dose; 7 (16.3%) BEV and 9 (20.9%) BEV + CPT-11 patients had a complete reduction of corticosteroid dose. The majority of patients who had an objective response or progression-free survival >6 months experienced corticosteroid dose reduction. Approximately 64% of patients who used corticosteroids while receiving BEV-based therapy experienced infection.
CONCLUSION:
BEV may have corticosteroid-sparing effects in patients with recurrent glioblastoma. Corticosteroid reduction may positively affect patient health-related quality of life. Given the exploratory nature of the analyses in a noncomparative study, these results should be interpreted cautiously.
AuthorsJames J Vredenburgh, Timothy Cloughesy, Meghna Samant, Michael Prados, Patrick Y Wen, Tom Mikkelsen, David Schiff, Lauren E Abrey, W K Alfred Yung, Nina Paleologos, Martin K Nicholas, Randy Jensen, Asha Das, Henry S Friedman
JournalThe oncologist (Oncologist) Vol. 15 Issue 12 Pg. 1329-34 ( 2010) ISSN: 1549-490X [Electronic] England
PMID21147867 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Randomized Controlled Trial)
Chemical References
  • Adrenal Cortex Hormones
  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Vascular Endothelial Growth Factor A
  • Bevacizumab
Topics
  • Adrenal Cortex Hormones (therapeutic use)
  • Adult
  • Angiogenesis Inhibitors (therapeutic use)
  • Antibodies, Monoclonal (therapeutic use)
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
  • Brain Neoplasms (drug therapy, pathology)
  • Female
  • Glioblastoma (drug therapy, pathology)
  • Humans
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local (drug therapy, pathology)
  • Neoplasm Staging
  • Salvage Therapy
  • Survival Rate
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A (antagonists & inhibitors, metabolism)

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