Patients With Proneural Glioblastoma May Derive Overall Survival Benefit From the Addition of Bevacizumab to First-Line Radiotherapy and Temozolomide: Retrospective Analysis of the AVAglio Trial

Sandmann T et al, 2015 Journal of Clinical Oncology                                      

Link to abstract: http://jco.ascopubs.org/content/early/2015/06/24/JCO.2015.61.5005.abstract

The previously reported AVAglio (Avastin in Glioblastoma) trial found prolonged progression-free survival (but not overall survival) in adult patients with GBM who had bevacizumab added to radiotherapy plus temozolomide.  This paper is a follow up from that study and looks to determine if certain sub-groups may actually have an OS benefit from adding avastin to first line standard of care.  The authors retrospectively grouped pre-treatment specimens from just over a third of patients enrolled in the study (349/921) using gene expression analysis and IDH1 mutation status.  They found that bevacizumab conferred an OS advantage versus placebo in patients with proneural IDH1 wild-type tumors (17.1 v 12.8 months, respectively; hazard ratio, 0.43; 95% CI, 0.26 to 0.73; P = .002).

*Take home message: With IDH1 mutations seen in 7 of 43 pediatric primary malignant gliomas treated on the Children’s Oncology Group ACNS0423 study (and therefore 36 of 43 WT) it will be interesting/important for us to see if this is validated when the results of the HERBY study are reported (see https://clinicaltrials.gov/ct2/show/NCT01390948).