Comparative analysis of the efficacy of temozomide and the combination of bevacizumab and irinotecan in the treatment of progression of primary highly malignant gliomas of the brain. Own experience

Study objective: a comparative analysis of the effectiveness of temozolomide and the combination of bevacizumab with irinotecan in the treatment of patients with continued growth of primary high-grade glioma of the brain to determine the most effective treatment option.Materials and Methods. The results of treatment of 70 patients with diagnosed progression of high-grade gliomas who were treated at the Chelyabinsk Regional Center of Oncology and Nuclear Medicine during the period from 2007 to 2022 were retrospectively evaluated. The ratio of men and women was equal (35 men and 35 women). The mean age of patients of both sexes was 51.1±2.7 years (ranging from 20 to 70 years). According to the histological report, glioblastoma (GB) was predominant in 45 patients, and anaplastic astrocytoma (AA) was diagnosed in 25 patients. Reoperative surgery was performed in 32 patients. Since the chemotherapeutic component in our study was represented by two regimens, we retrospectively allocated two groups. Group I included 27 patients who received irinotecan (125-200 mg/m2 intravenously) in combination with bevacizumab (5-10 mg/kg intravenously) on days 1 and 15 of a 28-day cycle. Group II consisted of 43 patients who received temozolomide monochemotherapy at a dose of 200 mg/m2 from days 1 to 5, every 28 days.Results. The median overall survival (OS) for all patients with continued growth of highly malignant brain gliomas was 36 months (95% CI 24.5-47.5). The 1-year OS was 97.1%, 2-year OS - 61.1%, and 3-year OS - 48.3%. Median OS after treatment for recurrence was 14 months (95% CI 10.2-17.7). The progression-free survival rates (PFS) were slightly higher in group II compared to group I patients, 18 months and 10 months, respectively (p>0.05). There was an increase in PFS in patients in the GB group after chemotherapy with bevacizumab + irinotecancompared to patients who received temozolomide, 17 months and 10 months, respectively, but without statistical significance (p>0.05). In the group of patients with progression of primary AA, the opposite pattern was observed: PFS was higher in group II patients compared to group I, 30 months and 26 months, but also without statistical significance (p>0.05). Toxic effects in patients treated with temozolomide were manifested as hematological abnormalities not exceeding grade 2, nausea of grade 1-2. In the group of patients treated with the bevacizumab+irinotecan regimen, no toxic effects were noted.Conclusion. The chemotherapy options used were comparable in efficacy and safety.