Bevacizumab and etoposide combination chemotherapy in patients with recurrent malignant gliomas who failed bevacizumab

Bevacizumab is the current standard of care treatment for recurring malignant glioma patients. However, most of the tumors become resistant to bevacizumab, and there is no standardized, effective chemotherapy for the malignant glioma patients after bevacizumab failure. Retrospective chart review was performed in order to identify the malignant glioma patients treated with oral, metronomic etoposide in combination with bevacizumab after being diagnosed with progressive disease while on bevacizumab. This review was approved by the Institutional Review Board (IRB) of the University of California, Irvine. Six malignant gliomas patients met the inclusion criteria. The median progression-free survival (PFS) for the anaplastic astrocytoma (AA) patients was eight months, and the overall survival was 28 months. The two Glioblastoma Multiforme (GBM) patients showed tumor progression after four to eight weeks of treatment with bevacizumab and etoposide, and died within four months of beginning the etoposide/bevacizumab regimen. In this limited study, patients with AA demonstrated prolonged control on combination treatment with bevacizumab and oral etoposide, despite initial tumor progression on bevacizumab. These results may warrant further investigation on a prospective clinical trial of this combination in AA patients who developed resistance to bevacizumab.