CCNU and Avastin for glioblastoma – pro
Glioblastoma is a disease for which there were few options available until recently. One popular and well supported combination is irinotecan and Avastin. A combination of bevacizumab and lomustine (CCNU) showed promise in a randomized phase II trial of patients with recurrent glioblastoma. The BELOB trial was a Dutch multicenter trial that included 148 patients randomized (130 available for review) to bevacizumab alone, lomustine alone, or bevacizumab in combination with lomustine. All patients had histologically proven glioblastoma, with a first recurrence after chemo-irradiation with temozolomide, and had concluded radiotherapy at least 3 months earlier. The 9-month overall survival (OS) rate (the study’s primary endpoint) was 43% in the lomustine alone group, 38% in the bevacizumab alone group, and 59% in the combination arm; if the eight initial patients before dose reduction were included, the combination arm’s rate was 63%. The median OS in each group was 8 months, 8 months, and 11 months for the combination arm (12 months with the first eight patients). The objective response rates were 5% (lomustine), 38% (bevacizumab), and 34% (or 39% with the first eight patients) in the combination group.
Taal W, OOsterkamp H, Walenkamp A, et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncology. 2014:15:943 – 953.