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. 2017 Jul 4;8(27):44015-44031.
doi: 10.18632/oncotarget.17054.

Survival benefit of glioblastoma patients after FDA approval of temozolomide concomitant with radiation and bevacizumab: A population-based study

Ping Zhu  1   2 , Xianglin L Du  1 , Guangrong Lu  2 , Jay-Jiguang Zhu  2
Affiliations

Survival benefit of glioblastoma patients after FDA approval of temozolomide concomitant with radiation and bevacizumab: A population-based study

Ping Zhu et al. Oncotarget. .

Abstract

Few population-based analyses have investigated survival change in glioblastoma multiforme (GBM) patients treated with concomitant radiotherapy-temozolomide (RT-TMZ) and adjuvant temozolomide (TMZ) and then bevacizumab (BEV) after Food and Drug Administration (FDA) approval, respectively. We aimed to explore the effects on survival with RT-TMZ, adjuvant TMZ and BEV in general GBM population based on the Surveillance, Epidemiology, and End Results (SEER) and Texas Cancer Registry (TCR) databases. A total of 28933 GBM patients from SEER (N = 24578) and TCR (N = 4355) between January 2000 and December 2013 were included. Patients were grouped into three calendar periods based on date of diagnosis: pre-RT-TMZ and pre-BEV (1/2000-2/2005, P1), post-RT-TMZ and pre-BEV (3/2005-4/2009, P2), and post-RT-TMZ and post-BEV (5/2009-12/2013, P3). The association between calendar period of diagnosis and survival was analyzed in SEER and TCR, separately, by the Kaplan-Meier method and Cox proportional hazards model. We found a significant increase in median overall survival (OS) across the three periods in both populations. In multivariate models, the risk of death was significantly reduced during P2 and further decreased in P3, which remained unchanged after stratification. Comparison and validation analysis were performed in the combined dataset, and consistent results were observed. We conclude that the OS of GBM patients in a "real-world" setting has been steadily improved from January 2000 to December 2013, which likely resulted from the administrations of TMZ concomitant with RT and adjuvant TMZ for newly diagnosed GBM and then BEV for recurrent GBM after respective FDA approval.

Keywords: bevacizumab; cancer registry; glioblastoma (GBM); overall survival; temozolomide.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Overall survival of GBM patients by calendar period of diagnosis in SEER, TCR and the combined dataset
(a) Crude overall survival in SEER; (b) Direct adjusted survival after adjusting covariates in SEER; (c) Crude overall survival in TCR; (d) Direct adjusted survival after adjusting covariates in TCR; (e) Crude overall survival in the combined dataset; (f) Direct adjusted survival after adjusting covariates in the combined dataset.
Figure 2
Figure 2. Overall survival of GBM patients by calendar period of diagnosis and age group at diagnosis in SEER, TCR and the combined dataset, Kaplan–Meier survival estimates
(a) Crude overall survival stratified by age group at diagnosis in SEER; (b) Crude overall survival stratified by age group at diagnosis in TCR; (c) Crude overall survival stratified by age group at diagnosis in the combined dataset.
Figure 3
Figure 3. Overall survival of GBM patients by calendar period of diagnosis and age group at diagnosis in SEER, TCR and the combined dataset, direct adjusted survival functions
(a) Direct adjusted survival after adjusting covariates stratified by age group at diagnosis in SEER; (b) Direct adjusted survival after adjusting covariates stratified by age group at diagnosis in TCR; (c) Direct adjusted survival after adjusting covariates stratified by age group at diagnosis in the combined dataset.
See this image and copyright information in PMC

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