Bevacizumab in recurrent glioblastoma

In May 2009, the U.S. Food and Drug Administration granted accelerated approval for the use of bevacizumab in patients with progressive glioblastoma (GBM), the most common malignant primary brain tumor in adults (1). Neovascularization is a morphologic hallmark of GBM, driven in part by vascular endothelial growth factor A (VEGF-A) which is targeted and neutralized by bevacizumab. Favorable results in early uncontrolled studies on the use of bevacizumab as salvage treatment in GBM led to wider use and further investigation in recurrent WHO grade II and III gliomas, which often exhibit enhancement akin to that seen in GBM. Until recently, only retrospective uncontrolled studies on the effect of bevacizumab in recurrent lower grade gliomas have been reported; van den Bent and colleagues offer results of the first and largest randomized trial in which the use of bevacizumab alone or in combination with maintenance-dose temozolomide was investigated in patients with a first and contrast-enhancing recurrence of WHO grade II or III astrocytoma (2)