High-grade gliomas (HGG) are the most common and aggressive neoplasms among primary central nervous system tumors. This type of cancer is mainly characterized by diffuse parenchymal infiltration and significant angiogenesis. Despite the advent of new therapies, the conventional treatment for patients who have been recently diagnosed with glioblastoma multiforme (GBM) offers a mean survival of around 14 months and a 2-year survival rate slightly higher than 25%, even including optimum surgical treatment and chemoradiotherapy.

A study recently published by Zuniga et al assessed the therapeutic efficacy, security, response pattern and recurrences in 51 patients with recurrent HGG treated with bevacizumab and irinotecan in the Henry Ford Hermelin Brain Tumor Center, United States, between 2005 and 2008. The bevacizumab and irinotecan combination was associated with a 6-month progression-free survival (PFS) of 78.6% for patients with anaplastic gliomas (AG) and of 63.7% for patients with glioblastomas.

Likewise, the median PFS was 13.4 months for patients with AG and 7.6 for those with glioblastomas. 6-month overall survival (OS) was 85.7% in patients with AG and 78% in those with glioblastomas. The 12-month OS was 77.9% for patients with AG and 42.6% for patients with glioblastomas. It is worth mentioning that patients with AG did not reach the mean OS, but those individuals with glioblastomas have reached a mean OS of 11.5 months.

Whereas 36 out of 51 patients (70.59%) achieved partial (32) or complete (4) radiological response to treatment, 8 (15.69%) remained stable. Distant progression, with or without local recurrences, was experienced by 23 out of the 38 subjects who had disease progression in the post-gadolinium studies. Seven patients experienced progression in the studies performed with the FLAIR technique (fluid attenuated inversion recovery technique), but there were no similar findings in the post-gadolinium sequences. Therapy was discontinued by 11.76% of the cohort due to the adverse events associated with treatment, including end-stage renal failure and gastric perforation. No symptomatic intracranial hemorrhages were observed during treatment.

Zuniga RM, Torcuator R, Jain R y col. Efficacy, safety and patterns of response and recurrence in patients with recurrent high-grade gliomas treated with bevacizumab plus irinotecan. J Neurooncol DOI 10.1007/s11060-008-9718-y