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Regorafenib in patients with recurrent high-grade astrocytoma
Sied Kebir1,2,3,4, Laurel Rauschenbach3,4,5, Alexander Radbruch6
1Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany.
Purpose:
Antiangiogenic treatment approaches have failed to improve outcome in randomized trials of high-grade astrocytoma. One key mechanism of resistance to antiangiogenic treatment may concern the upregulation of alternative pro-angiogenic pathways. Regorafenib is a potent multikinase inhibitor that may alter some of those pathways. In this retrospective study, we investigated efficacy and radiographic tumor growth patterns of regorafenib in recurrent high-grade astrocytoma.
Methods:
We screened for patients with high-grade astrocytoma in whom regorafenib was administered for at least 4 weeks. We assessed treatment efficacy in terms of progression-free survival (PFS), overall survival, and adverse events defined by Common Toxicity Criteria (CTC). In addition, radiographic tumor growth patterns were determined at baseline and recurrence.
Results:
A total of 6 patients met eligibility criteria. The number of recurrences prior to regorafenib varied between 2 and 6. Patients were on regorafenib treatment for at least 4 weeks and maximally 14 weeks. Median PFS was 3.5 months and ranged from 2.0 to 4.0 months. Radiographic response was progressive disease in all patients with an objective response rate of 0%. CTC°3 adverse events were observed in all but one patient. The most common radiographic growth pattern was local with no change in growth pattern at recurrence. An infiltrative tumor growth was not induced in any patient.
Conclusions:
This retrospective study indicates a very poor performance of regorafenib in recurrent high-grade astrocytoma with a fairly high number of CTC°3 adverse events. In addition, regorafenib does not seem to bear a potential for infiltrative tumor growth promotion.
Insights
Regorafenib showed poor efficacy in recurrent high-grade astrocytoma, with no objective responses and significant adverse events. The drug did not promote infiltrative tumor growth in this small patient group.
Area of Science:
- Neuro-oncology
- Cancer therapy
- Clinical research
Background:
- Antiangiogenic therapies have not improved outcomes for high-grade astrocytoma.
- Resistance may involve alternative pro-angiogenic pathways.
- Regorafenib is a multikinase inhibitor with potential to target these pathways.
Purpose of the Study:
- To investigate the efficacy and radiographic tumor growth patterns of regorafenib in recurrent high-grade astrocytoma.
- To assess progression-free survival (PFS), overall survival, and adverse events.
- To analyze radiographic tumor growth patterns before and after treatment.
Main Methods:
- Retrospective study of 6 patients with high-grade astrocytoma treated with regorafenib for at least 4 weeks.
- Efficacy assessed by PFS, overall survival, and Common Toxicity Criteria (CTC) for adverse events.
- Radiographic tumor growth patterns evaluated at baseline and recurrence.
Main Results:
- Median PFS was 3.5 months (range 2.0-4.0 months) across 6 patients.
- All patients had progressive disease, resulting in a 0% objective response rate.
- CTC grade 3 adverse events occurred in 5 out of 6 patients; local tumor growth was the predominant pattern.
Conclusions:
- Regorafenib demonstrated very poor performance in recurrent high-grade astrocytoma.
- High rates of grade 3 adverse events were observed.
- Regorafenib did not appear to promote infiltrative tumor growth.
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