PracticeUpdate: Haematology & Oncology

CONFERENCE COVERAGE 12

Bevacizumab + irinotecan shows promise in recurrent glioblastoma T he combination of bevacizumab and irinotecan has been shown to be poten- tially beneficial in recurrent glioblastoma multiforme, report results of a retrospective analysis of experience at a single institution. Charlotte Besson, MD, of the Centre Paul Strauss, Strasbourg, France, explained that in the absence of standard treatment for recurrent glioblastoma in Europe, numerous prospective and retrospective studies have evaluated the combination of bevacizumab + irinotecan. Dr Besson and colleagues reported on their centre’s experience with this off-label combination. Dr Besson and coinvestigators analysed consecutive patients treated initially by the Stupp protocol and secondly with bevacizumab for glioblastoma between 2007 and 2013. Times to progression and overall survival, as well as toxicities, were investigated. Eighty-two patients were eligible for analysis. Median age at diagnosis was 59 years (range 25–80) and median World Health Organisation performance status at recur- rence was 1.23 (range 0–3). Sixty patients (73%) experienced toxicities related to bevacizumab. These were mainly grades 1 and 2 (92%), such as hypertension, pro- teinuria, haemorrhage, thrombosis, nausea, diarrhoea, fatigue, and neutropenia of grades 3 (n=9) and 4 (n=1). Estimates of Kaplan-Meier median progression-free and overall survival at recur- rence, calculated from the start of bevacizumab + irinotecan, were 6.5 (95% CI 7.8) and 10.7 months (95% CI interval 8.5–12.5), respectively. These were close to results of other prospective and retrospective studies, but were observed in older patients than those trials (median age ranged from 44.7–57 years in previous studies). Median overall survival calculated from diagnosis was 23 months (95% CI 20.5– 24.9). Multivariate analysis showed that O6-methylguanine-DNA methyltransferase status (methylated vs unmethylated) exerted no effect on progression-free survival before the first recurrence. Similarly, neither age ( ≥ 70 years vs <70 years) nor World Health Organisation per- formance status exerted a significant influence on overall survival. This suggested that this combination might be applicable to some frail patients. On the other hand, new surgery of recurrent glioblastoma (n=18) improved survival at recurrence sig- nificantly (P = 0.029). Dr Besson concluded that the combination of bevacizumab + irinotecan was well tolerated and may offer clinical benefit in patients with recurrent glioblastoma. Moreover, surgery at recurrence was suggested to be associated with prolonged sur- vival. The results are in line with previous studies and strengthen the role of these agents for recurrent glioblastoma.

Lenvatinib proves effective across tumour burdens in differentiated cancer of the thyroid L envatinib has been proven effective across tumour burdens in a phase III trial in differentiated thyroid cancer. This finding was based on the baseline characteristics of responders vs nonresponders from the Study of (E7080) Lenvatinib in differentiated Cancer of the Thyroid (SELECT). Christoph W. Reuter, MD, of Hannover Medical School, Germany, explained that in SELECT, lenvatinib improved progression-free survival in patients with differentiated thyroid cancer vs placebo (18.3 vs 3.6 months, hazard ratio 0.21, 99% confidence interval 0.14–0.31, P < 0.0001). Dr Reuter reported on the change in the sum of target lesion diameter in patients from SELECT who did and did not respond to lenvatinib. Patients were randomised 2:1 to lenvatinib 24 mg daily or placebo. Tumours were assessed by independent radiologic review every 8 weeks during randomisation and by investigator review every 12 weeks during the extension phase. Response was defined as the demonstration of either a partial or complete response. All other outcomes were categorised as nonresponse. Of 261 lenvatinib-treated patients, 169 were responders and 92 nonresponders. Among responders, 66% were age ≤ 65 years and 46% were male. Forty- eight percent of nonresponders were age ≤ 65 years and 51% were male. Responders showed lower tumour burden than nonresponders. Among responders, 33% had baseline tumour burden ≤ 35 mm and 67% were Eastern Cooperative Oncology Group performance status 0. Among nonresponders, 10% had baseline tumour burden ≤ 35 mm and 34% were Eastern Cooperative Oncology Group performance status 0. The median duration of treatment was longer in responders than in nonresponders (14 [range 1.1– 26.8] months vs 5.5 [range 0.2–21.5] months). Median baseline sum of target lesion diameters was 51.8 mm (range 15.1–181.2) among responders, and median maximum percent change from baseline was –52% (range –100% to –30%). Among nonresponders, median baseline sum of target lesion diameters was 71.5 mm (range 15.9–331.2) and median maximum percent change from baseline was –20% (range –38% to 66%). Dr Reuter concluded that lenvatinib was effective across tumour burdens in SELECT. In this analysis, the per- centage of responders with lower tumour burden was higher than in nonresponders. The data suggest that earlier use of lenvatinib could be beneficial in patients with differentiated cancer of the thyroid.

PracticeUpdate Editorial Team

PracticeUpdate Editorial Team

© ECCO2017 European Cancer Congress

PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY