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Vol. 69, No. 2, 2013
Issue release date: February 2013
Eur Neurol 2013;69:95–101

Bevacizumab Alone or in Combination with Irinotecan in Recurrent WHO Grade II and Grade III Gliomas

Seystahl K. · Wiestler B. · Hundsberger T. · Happold C. · Wick W. · Weller M. · Wick A.
aDepartment of Neurology, University Hospital Zurich, Zurich, Switzerland; bDepartment of Neurooncology, University Hospital Heidelberg, Heidelberg, Germany; cDepartment of Neurology and Haematology/Oncology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland

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Background: The repertoire of salvage regimens for patients with WHO grade II and III gliomas recurring or progressing after surgery, radiotherapy and temozolomide chemotherapy is limited. Based on promising response and progression-free survival (PFS) data in recurrent glioblastoma, the use of bevacizumab (BEV) has been extended to recurrent grade II/III gliomas. Methods: We retrospectively assessed the safety and efficacy of BEV alone or combined with irinotecan in 39 patients with recurrent grade II/III gliomas. Results: Both BEV monotherapy and its combination with irinotecan were well tolerated. Response rates were 26% as monotherapy and 33% in combination using Macdonald and RANO criteria. The median PFS was 4.2 months and the PFS rate at 6 months 29% for BEV alone, and 4.7 months and 42% for the combination. The median overall survival was 14.8 months for BEV monotherapy and 8.1 months for the combination. Outcome after failure of BEV was better when patients continued BEV beyond progression. Conclusion: BEV has limited activity in recurrent grade II/III gliomas. The additional value of irinotecan remains questionable. Prospective studies with BEV-free control groups are required to better define the role of BEV among the limited options in patients with recurrent grade II/III gliomas.

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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