贝伐珠单抗治疗复发胶质母细胞瘤疗效和预后分析

  目的   探讨贝伐珠单抗治疗复发胶质母细胞瘤的疗效及预后因素。  方法  回顾性分析2011年12月至2020年7月中山大学肿瘤防治中心接受贝伐珠单抗治疗的81例成人复发胶质母细胞瘤患者的临床资料，评价其疗效和不良反应，以总生存期为预后指标进行单因素和Cox比例风险模型多因素分析。  结果  81例患者的客观有效率为62.9%，疾病控制率为80.2%，90.1%的患者生存质量状况（KPS）评分和神经症状有改善。中位无进展生存期（median progression-free survival，mPFS）和中位总生存期（median overall survival，mOS）分别为4.4个月（95%CI:4.0～4.8）和7.8个月（95%CI:6.8～8.8）。单因素分析显示用药时机（首次或≥2次复发时用药）、剂量（5 mg/kg，6～9 mg/kg，10 mg/kg）和是否联合化疗对mOS无影响，多因素分析显示KPS评分和MGMT启动子甲基化状态是影响mOS的独立预后因素。不良事件主要为1～2级。  结论  贝伐珠单抗可以改善成人复发胶质母细胞瘤患者的生存质量，治疗耐受性好。KPS评分和MGMT启动子甲基化状态是影响mOS的独立预后因素，贝伐珠单抗在复发后的用药时机、剂量、是否联合化疗对mOS无影响。 

Analysis of prognosis and efficacy of bevacizumab for recurrent glioblastoma

  Objective  To investigate the efficacy of bevacizumab and prognostic factors for recurrent glioblastoma.   Methods  Clinical data of 81 patients receiving bevacizumab in Cancer Center of Sun Yat-sen University from December 2011 to July 2020 were retrospectively analyzed to evaluate the efficacy and adverse effects of bevacizumab, with overall survival (OS) as the prognostic index in the univariate and Cox proportional risk models.   Results  The objective response rate of 81 patients was 62.9%, and the disease control rate was 80.2%; 90.1% of patients had improved quality of life status (KPS) score and neurological symptoms. The median progression-free survival(mPFS) and median OS were 4.4 months (95% CI: 4.0-4.8) and 7.8 months (95% CI: 6.8-8.8), respectively. Univariate analysis showed that the number of relapse (medication at the first or second relapse), medication regimen (single agent or combination chemotherapy), and dose (5, 6-9, and 10 mg/kg) had no effect on median OS. Multivariate analysis revealed that the KPS score and MGMT promoter methylation status were independent prognostic factors affecting median OS. Adverse events occurred were mainly grade 1-2.   Conclusions  Bevacizumab can improve the quality of life of adult patients with recurrent glioblastoma. The KPS score and MGMT promoter methylation status were independent prognostic factors that affected median OS. The timing or dose of bevacizumab use or its combination with chemotherapy had no effect on the median OS of patients.