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Published on: March 20, 2026
An exploratory survival analysis of anti-angiogenic therapy for recurrent malignant glioma
Andrew D Norden1, Jan Drappatz, Alona Muzikansky
1Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. anorden@partners.org
Abstract:
Recent clinical trial results suggest that anti-angiogenic therapy may be effective against recurrent malignant glioma. Though these treatments prolong progression-free survival, the extent to which they prolong overall survival is unknown. We pooled data from 34 patients treated at a single institution on phase II clinical trials of bevacizumab and cediranib, and we compared these data to 18 patients treated on clinical trials of cytotoxic chemotherapies. In univariate and multivariate analyses, treatment group was a significant predictor of progression-free but not overall survival. Median progression-free survival was 8 vs. 22 weeks in patients treated with cytotoxic as compared to anti-angiogenic therapy (P = 0.01). Median overall survival was nearly identical in the two groups (39 vs. 37 weeks). The results of this exploratory analysis suggest that anti-angiogenic therapy may fail to prolong overall survival in patients with recurrent malignant glioma. If this conclusion proves correct, progression-free survival may be an inappropriate endpoint for phase II trials of anti-angiogenic therapies.
Insights
Anti-angiogenic therapy for recurrent malignant glioma extended progression-free survival but not overall survival. This suggests progression-free survival may be an unsuitable endpoint for these trials.
Area of Science:
- Neuro-oncology
- Clinical pharmacology
- Cancer therapy research
Background:
- Recurrent malignant glioma presents a therapeutic challenge.
- Anti-angiogenic therapies show promise in prolonging progression-free survival (PFS).
- The impact of anti-angiogenic therapy on overall survival (OS) in this setting remains unclear.
Purpose of the Study:
- To evaluate the efficacy of anti-angiogenic therapy versus cytotoxic chemotherapy in recurrent malignant glioma.
- To compare progression-free survival (PFS) and overall survival (OS) between treatment groups.
- To assess the suitability of PFS as an endpoint in phase II trials for anti-angiogenic agents.
Main Methods:
- Retrospective pooled analysis of 34 patients receiving anti-angiogenic therapy (bevacizumab and cediranib).
- Comparison with 18 patients receiving cytotoxic chemotherapies from phase II clinical trials.
- Univariate and multivariate analyses were performed to assess survival outcomes.
Main Results:
- Anti-angiogenic therapy significantly improved median PFS (22 weeks) compared to cytotoxic chemotherapy (8 weeks) (P=0.01).
- Median OS was similar between groups: 37 weeks for anti-angiogenic therapy and 39 weeks for cytotoxic chemotherapy.
- Treatment group was a significant predictor of PFS but not OS in multivariate analysis.
Conclusions:
- Anti-angiogenic therapy may not prolong overall survival in patients with recurrent malignant glioma.
- Progression-free survival may be an inappropriate endpoint for phase II trials of anti-angiogenic therapies in this patient population.
- Further investigation is warranted to confirm these findings and guide future trial design.
