Wick W, et al. - Researchers contemplated the possibility of lomustine and bevacizumab combination therapy leading to longer overall survival than lomustine alone, among patients at the first progression of glioblastoma. Findings revealed somewhat prolonged progression-free survival. Nonetheless, it was brought to light that lomustine plus bevacizumab therapy did not confer a survival advantage over treatment with lomustine alone in the study cohort.

Methods

• Patients were assigned with progression after chemoradiation in a 2:1 ratio to receive lomustine plus bevacizumab (combination group, 288 patients) or lomustine alone (monotherapy group, 149 patients).
• A scrutiny was performed of the methylation status of the promoter of O6-methylguanine-DNA methyltransferase (MGMT).
• In addition, an assement was carried out of the health-related quality of life and neurocognitive function at baseline and every 12 weeks.
• The primary end point comprised of the overall survival.

Results

• Randomization was conducted of 437 patients.
• It was revealed that the median number of 6-week treatment cycles was three in the combination group and one in the monotherapy group.
• The combination therapy did not provide a survival advantage, with 329 overall survival events (75.3%); the median overall survival was 9.1 months (95% confidence interval [CI], 8.1 to 10.1) in the combination group and 8.6 months (95% CI, 7.6 to 10.4) in the monotherapy group (hazard ratio for death, 0.95; 95% CI, 0.74 to 1.21; P=0.65).
• Locally assessed progression-free survival was determined as being 2.7 months longer in the combination group when compared to the monotherapy group: 4.2 months vs 1.5 months (hazard ratio for disease progression or death, 0.49; 95% CI, 0.39 to 0.61; P < 0.001).
• The occurrence of grade 3 to 5 adverse events was noted in 63.6% of the patients in the combination group and 38.1% of the patients in the monotherapy group.
• The addition of bevacizumab to lomustine did not exert an impact on the health-related quality of life and the neurocognitive function.
• The MGMT status was discovered to be prognostic.