Bevacizumab as first-line therapy for glioblastoma

Bevacizumab is a monoclonal antibody that binds and neutralizes VEGF. Bevacizumab is currently indicated as monotherapy for recurrent glioblastoma. Recent data from Phase II trials of bevacizumab as first-line therapy for glioblastoma have been promising, and have led to two Phase III trials evaluating the use of bevacizumab as first-line therapy when combined with radiation and temozolomide. Potential complications relating to interpretation of the results of these Phase III studies include the crossover use of bevacizumab upon recurrence in the placebo arm. Recently published single-arm evaluations of adding bevacizumab to standard first-line therapy in glioblastoma multiforme have shown an improvement in progression-free survival and overall survival when compared with historical controls obtained prior to widespread use of bevacizumab in recurrent glioblastoma multiforme. When these data are compared with more contemporary studies from the bevacizumab era, the improvement in progression-free survival seems to be maintained but the impact on overall survival with first-line bevacizumab therapy seems less clear. Bevacizumab therapy alters the imaging characteristics of glioblastoma, and new criteria have been established to assess treatment response and progression in the setting of widespread bevacizumab use.