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Updated: Jul 3, 2026
Tumor Treating Field Therapy in Combination with Bevacizumab for the Treatment of Recurrent Glioblastoma
Published on: October 27, 2014
Advancements in Glioblastoma Multiforme Treatment: A Comprehensive Systematic Review and Meta-Analysis
Kayode Agboola1,2, Fatemeh Khafaji3, Bipin Chaurasia4
1Facharztzentrum for Surgery and Orthopaedics, Essen, Germany.
Background:
Glioblastoma multiforme (GBM) poses significant challenges in oncology, with limited treatment options and poor prognosis. Despite advancements, recurrence remains common, emphasizing the need for effective therapeutic strategies. This meta-analysis comprehensively evaluates the efficacy and safety of treatments like bevacizumab (BEV), temozolomide (TMZ), and lomustine (CCNU) for recurrent GBM (rGBM), aiming to identify optimal approaches and guide clinical decisions.
Methods:
Following Preferred Reporting Standards for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted, and randomized controlled trials assessing interventions for rGBM were included. The Cochrane risk-of-bias assessment was used to evaluate study quality. Primary outcomes included progression-free survival (PFS) and overall survival (OS), whereas adverse events were assessed as secondary outcomes.
Results:
Nine articles met the inclusion criteria, comprising a total of 1689 participants. BEV therapy outperformed pre-BEV treatment across several parameters, including full resection (odds ratio [OR] = 14.50, 95% confidence intervals [CI]: 1.82-115.29, p = 0.01) and biopsy outcomes (OR = 18.67, 95% CI: 2.55-136.41, p = 0.04). BEV also demonstrated higher rates of MGMT promoter methylation at baseline (OR = 11.84, 95% CI: 1.87-74.77, p = 0.009), as well as associations with improved PFS (OR = 1.16, 95% CI: 0.10-2.22, p = 0.03) and OS (OR = 0.63, 95% CI: 0.01-1.26, p = 0.05) compared to pre-BEV therapies. BEV monotherapy was associated with more favorable outcomes than combination therapies, with a pooled OR of 19.50 (95% CI: 2.69-141.35, p = 0.03) for corticosteroid use. Adverse event analysis revealed a lower incidence of CNS hemorrhage with standard therapy. TMZ outperformed the TMZ + CCNU combination in PFS (OR = 2.44, 95% CI: 1.23-4.83, p = 0.01), OS, and MGMT methylation (OR = 2.58, 95% CI: 1.40-4.78, p = 0.002).
Conclusion:
BEV monotherapy emerges as a promising treatment for rGBM, with favorable outcomes in biopsy results, corticosteroid use, PFS, and OS. Future research is needed to confirm these findings and optimize BEV's clinical application, emphasizing tailored treatment strategies to improve patient prognosis.
Insights
Bevacizumab (BEV) monotherapy shows promise for recurrent glioblastoma multiforme (rGBM), improving outcomes like progression-free survival. Temozolomide (TMZ) also outperformed combination therapy for rGBM.
Area of Science:
- Neuro-oncology
- Clinical pharmacology
- Evidence-based medicine
Background:
- Glioblastoma multiforme (GBM) presents significant therapeutic challenges with high recurrence rates.
- Limited effective treatment options necessitate novel strategies for recurrent GBM (rGBM).
Purpose of the Study:
- To evaluate the efficacy and safety of bevacizumab (BEV), temozolomide (TMZ), and lomustine (CCNU) for rGBM.
- To identify optimal treatment approaches for recurrent glioblastoma.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of randomized controlled trials for rGBM interventions.
- Assessment of progression-free survival (PFS), overall survival (OS), and adverse events using Cochrane risk-of-bias tool.
Main Results:
- Bevacizumab (BEV) monotherapy demonstrated superior outcomes compared to pre-BEV treatments, including improved biopsy results and progression-free survival (PFS).
- Temozolomide (TMZ) showed better PFS and MGMT promoter methylation rates than the TMZ + CCNU combination.
- BEV monotherapy was associated with more favorable corticosteroid use and fewer CNS hemorrhages compared to combination therapies.
Conclusions:
- Bevacizumab (BEV) monotherapy is a promising treatment for recurrent glioblastoma, enhancing biopsy results, corticosteroid use, PFS, and OS.
- Further research is warranted to optimize BEV's clinical application and personalize treatment strategies for rGBM patients.
