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Bevacizumab plus hypofractionated radiotherapy versus radiotherapy alone in elderly patients with glioblastoma: Efficacy and imaging analyses of the ARTE trial.
Journal article

Bevacizumab plus hypofractionated radiotherapy versus radiotherapy alone in elderly patients with glioblastoma: Efficacy and imaging analyses of the ARTE trial.

  • Wirsching, Hans-Georg Department of Neurology, University Hospital, Zürich, Switzerland;
  • Tabatabai, Ghazaleh Department of Neurology, University Hospital, Zürich, Switzerland;
  • Roelcke, Ulrich Brain Tumor Center, Kantonsspital Aarau, Aarau, Switzerland;
  • Hottinger, Andreas Felix Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
  • Schmid, Andrea Department of Medical Oncology, Bern, Switzerland;
  • Plasswilm, Ludwig Department of Radiation-Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland;
  • Conen, Katrin Lisa University Hospital Basel, Riehen, Switzerland;
  • Hundsberger, Thomas Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland;
  • Caparrotti, Francesca Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland;
  • Von Moos, Roger Department of Medical Oncology, Kantonsspital Graubuenden, Chur, Switzerland;
  • Riklin, Christian Alexander Department of Medical Oncology, Kantonsspital Luzern, Lucerne, Switzerland;
  • Remonda, Luca Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland;
  • Roth, Patrick Department of Neurology, University Hospital, Zürich, Switzerland;
  • Held, Leonhard Biostatistics Department, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland;
  • Rushing, Elisabeth Jane University Hospital Zurich, Department of Neuropathology, Zurich, Switzerland;
  • Ochsenbein, Adrian Inselspital, Bern, Switzerland;
  • Weller, Michael Laboratory of Molecular Neuro-Oncology, Department of Neurology, and Neuroscience Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland;
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Published in:
  • Journal of Clinical Oncology. - American Society of Clinical Oncology (ASCO). - 2017, vol. 35, no. 15_suppl, p. 2014-2014
Cancer Research
Oncology
English 2014 Background: The addition of bevacizumab (BEV) to first-line temozolomide chemoradiotherapy prolonged progression-free survival (PFS), but not overall survival (OS) in newly diagnosed glioblastoma in two phase III trials. Elderly and frail patients are underrepresented in most clinical trials, but early uncontrolled reports of BEV treatment of glioblastoma suggested preferential benefit in this patient population. Methods: ARTE was a 2:1 randomized, multi-center, open-label trial of hypofractionated radiotherapy (RT) in combination with intravenous BEV every 2 weeks (Arm A, N = 50) versus RT alone (Arm B, N = 25) in patients with newly diagnosed glioblastoma aged 65 years or older. Quality of life (QoL) was monitored by the EORTC QLQ-C30/BN20 modules. Response was assessed using Response Assessment in Neuro-Oncology (RANO) criteria. Exploratory imaging studies included apparent diffusion coefficient (ADC) mapping and 18F-fluoro-ethyl-tyrosine (FET) positron emission tomography (PET). Results: Established prognostic factors including age, Karnofsky performance score (KPS), O6-methylguanine DNA methyltransferase (MGMT) gene promoter methylation and steroid intake at study entry were balanced between arms. Median PFS was longer in Arm A vs. Arm B (7.6 vs. 4.8 months, p = 0.003), but OS was similar (12.1 vs 12.2 months, p = 0.8). Prior to progression, no differences in QoL were noted, but clinical deterioration was deferred in Arm A vs. Arm B. In a Cox model that controlled for established prognostic factors, an association with prolonged PFS was detected for Arm A versus Arm B (hazard ratio [HR] 0.36, p = 0.001) and for KPS 90-100% versus 60-80% (HR 0.50, p = 0.02). Applying a similar Cox model to OS detected an association with age 65-69 vs 70+ (HR 0.52, p = 0.02) and KPS 90-100% versus 60-80% (HR 0.53, p = 0.03). Exploration of imaging predictors of OS for Arm A identified response by RANO (HR 0.52, p = 0.02), but detected no prognostic role for T2, ADC or FET signal intensity. Conclusions: Efficacy outcomes and exploratory imaging analyses of the ARTE trial do not support the notion that benefit from BEV is more pronounced in elderly glioblastoma patients. Clinical trial information: NCT01443676.
Language
  • English
Open access status
closed
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Persistent URL
https://folia.unifr.ch/global/documents/296158
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