Vol.:(0123456789) 1 3 J Neurooncol DOI 10.1007/s11060-017-2477-x TOPIC REVIEW The role of bevacizumab in the treatment of glioblastoma Roberto Jose Diaz 1  · Sheikh Ali 2  · Mehreen Gull Qadir 3  · Macarena I. De La Fuente 4  · Michael E. Ivan 5  · Ricardo J. Komotar 5   Received: 11 October 2016 / Accepted: 15 May 2017 © Springer Science+Business Media New York 2017 additional beneft reported to date in health-related quality of life with the use of bevacizumab, although it may reduce steroid requirements. On average there is one side-efect event per patient and 74% of these events are grade 3 toxic- ity or higher. Further studies investigating the role of beva- cizumab in combination with cytotoxic agents at recurrence are awaited. Keywords Avastin · Bevacizumab · VEGF · Glioblastoma · Chemotherapy · Survival Introduction Glioblastoma (GBM) is the most common malignant pri- mary brain tumor in adults. Despite advancements in GBM treatment, such as the Stupp protocol,[1] it remains an incurable disease. While an efective medical therapy remains elusive, surgical resection of recurrent tumor in a selected group of patients appears benefcial [2]. Multiple adjuvant therapies have been proposed at the time of GBM recurrence including cytotoxic chemotherapy, angiogenesis inhibitors, or immunotherapy [3]. The histology of GBM is characterized by marked microvascular proliferation and disruption of the blood brain barrier, which results in con- trast enhancement on MRI. This is associated with overex- pression of the vascular endothelial growth factor (VEGF- A) [4]. Bevacizumab is an IgG1 humanized monoclonal antibody that neutralizes the efect of VEGF-A [2]. The FDA has approved bevacizumab for use in the treatment of multiple cancers including colon (2004), lung (2006), kid- ney (2009), and cervix (2014) cancers. In 2009, the FDA approved the use of bevacizumab in treating adult patients diagnosed with recurrent GBM based on the success of two Phase 2 clinical trials [5, 6]. Subsequent clinical use of Abstract Bevacizumab has been used in patients with GBM as a salvage therapy since its approval in the United States for recurrent GBM in 2009. In order to review the therapeutic efect of bevacizumab in the primary and recur- rent clinical setting we have performed a systematic analy- sis of data from the published literature. Weighted median progression free survival and overall survival were calcu- lated and compared to standard therapy or other experi- mental therapies. A qualitative analysis of the limited stud- ies on health related quality of life and efects on steroid requirements was also undertaken. We found that the avail- able literature supports the use of bevacizumab for prolong- ing PFS and OS in the recurrent setting either alone or in combination with a cytotoxic agent (P < 0.05), but does not support its use in the primary setting (P > 0.05). The sur- vival advantage of bevacizumab compared to experimental therapy at recurrence is limited to 4 months. There is no Electronic supplementary material The online version of this article (doi:10.1007/s11060-017-2477-x) contains supplementary material, which is available to authorized users. * Roberto Jose Diaz roberto.diaz@mcgill.ca 1 Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue University, Montreal H3A 2B4, QC, Canada 2 College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA 3 Department of Biological Sciences, Florida International University, Miami, FL, USA 4 Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA 5 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA