More bad news for bev.

Last week revealed a failure of bevacizumab in lung cancer. Now its use in glioblastoma multiforme (GBM) is on the chopping block. Bev is commonly used in recurrent GBM due to limited data showing reduced need for steroids and improved progression free--but not overall--survival. However, the actual “response” to bev has been called into question because of its “pseudoresponse” phenomenon via reducing tumor enhancement on imaging. As such, Response Assessment in Neuro-Oncology (RANO) criteria have been modified to account for non-enhancing progression on anti-angiogenic agents. Last week, the results of EORTC 26101 were published in NEJM comparing lomustine +/- bev in refractory and/or recurrent GBM. Again, bev slightly prolonged progression free survival but did not impact overall survival. Notably, the RANO criteria used to assess progression in this study did not include FLAIR/T2 MRI changes, and, on central review per the authors’ own T2 criteria, there was an even less impressive improvement in progression. Not to mention that adding bev failed to reduce steroid use or to improve quality of life. Bottom line: folks are seriously starting to question the actual versus perceived efficacy of bevacizumab for recurrent GBM.