Salvage Chemotherapy with Bevacizumab for Recurrent Anaplastic Glioma

Background: The treatment of recurrent anaplastic glioma (AG) like all high-grade gliomas (HGG) is problematic, as only partially effective therapeutic modalities are available and there is a lack of a standard therapy for recurrence. Methods: A literature review of the use of bevacizumab for recurrent HGG including five studies involving recurrent AG. Results: In the 5 studies of bevacizumab for the treatment of recurrent AG (n=140 patients) neuroradiographic response rates were as follows; complete response 0-20%, partial response 34-68% (median 52%), and stable disease 5-59% (median 16%). Median overall survival was 28 weeks (range 18-35 weeks) and progression free survival at 6- and 12-months was 55% (range 32-68%) and 23% (16-39%) respectively. Conclusions: Bevacizumab therapy appears to increase response of recurrent AG by 2-fold and 6- month progression free survival by 1.5 fold without a clear benefit with respect to overall survival. Toxicity of bevacizumab therapy is manageable and most often comprised of hypertension, proteinuria and fatigue. To date, there are no multi-institutional prospective trials evaluating the role of bevacizumab for the treatment of recurrent AG notwithstanding the increasingly common use of bevacizumab for this indication.