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. 2010 Jun 2:10:252.
doi: 10.1186/1471-2407-10-252.

Effects of bevacizumab plus irinotecan on response and survival in patients with recurrent malignant glioma: a systematic review and survival-gain analysis

Tao Xu  1 , Juxiang Chen, Yicheng Lu, Johannes Ea Wolff
Affiliations

Effects of bevacizumab plus irinotecan on response and survival in patients with recurrent malignant glioma: a systematic review and survival-gain analysis

Tao Xu et al. BMC Cancer. .

Abstract

Background: The combination of bevacizumab and irinotecan is a new chemotherapy protocol increasingly used for recurrent malignant glioma. Results from phase II trials suggest this drug combination is beneficial to patients, but no conclusive comparisons between this and other treatment protocols have been published.

Methods: We performed a systematic review and survival gain analysis of phase II studies to evaluate the efficacy and safety of bevacizumab plus irinotecan treatment. To do this, we utilized a preexisting database from which the mean overall survival and response rate of patients could be predicted. Survival gain, which characterized the influence of treatment, was defined as the difference between observed and predicted mean overall survival. Response gain was calculated similarly.

Results: 741 cohorts were enrolled in the database. Among them, 282 cohorts were based on recurrent adult HGG, mean reported median overall survival was 10.96 +/- 8.4 months, and mean response rate was 18.9% +/- 20.5. We found that compared with other treatment protocols, bevacizumab plus irinotecan largely improved response rates (P = 0.00002) and had a possible moderate effect on overall survival time (P = 0.024). Hemorrhage, thromboembolic complications, and gastrointestinal toxicities were the most frequently reported side effects.

Conclusion: The combination of bevacizumab and irinotecan might improve outcome in patients with recurrent malignant glioma. Randomized controlled trials are recommended to evaluate this treatment protocol and the additional value of irinotecan.

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Figures

Figure 1
Figure 1
Observed median overall survival and percentage of 1-year overall survival for patients with malignant glioma in all published data. These data showed a median overall survival time of 13.7 ± 11.1 months and 1-year overall survival percentage of 18.9 ± 21.1% for malignant glioma patients.
Figure 2
Figure 2
Distribution of treatment response rates for patients with malignant glioma in all published data. The mean response rate was 23.3 ± 22.3% in 326 studies.
Figure 3
Figure 3
Response gain distribution in control group (a) and bevacizumab plus irinotecan group (b). The combination of bevacizumab and irinotecan showed benefit in treatment response for patients with recurrent HGG.
Figure 4
Figure 4
Survival gain distribution in control group (a) and bevacizumab plus irinotecan group (b). The combination of bevacizumab and irinotecan showed benefit in survival time for patients with recurrent HGG.
See this image and copyright information in PMC

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