Long term response to Bevacizumab to an initially resistant - - PowerPoint PPT Presentation

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Long term response to Bevacizumab to an initially resistant glioblastoma

Tarek ASSI Institut Gustave ROUSSY - Paris

Brain tumors – Athens – 28-29 september

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 No conflict of interests

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Initial Presentation

 Age : 38 years.  History of diabetes and HTA.  December 2011: Generalized

seizure.

 Diagnosis of a parasagittal

precentral frontal glioblastoma.

 Surgery performed with complete

resection of the brain tumor.

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Adjuvant Therapy

 January 2012:

– STUPP protocol:

• Radiotherapy of 60 Gy in 30 sessions
• Temozolomide 150 mg per day during radiotherapy.
• Received two cycles of Temozolomide 200 mg/m2 = 400 mg

for 5 days every 4 weeks

– After the second cycle = A new generalized seizure.

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First relapse therapy

 MRI of the brain performed:

– Multinodular increased contrast enhancement in the frontal lobe region.

 Decision to start Lomustine

– Due to logistic issues: Procarbazine 60mg/m2 for 2 weeks every 4 weeks.

• September 2012 (After 3 months),
• Aphasia and somnolence
• MRI : increased contrast

enhancement with local frontal lobe progression.

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Second relapse therapy

 Avastin 10mg/kg every 2 weeks at

the dose of 770mg started on August 2012.

– Initial decreased contrast enhancement with persistent response. – After two years, increased proteinuria with decision to maintain Avastin at the dose of 15 mg/kg every 3 weeks – Persistent response for 3 years until September 2015

After 4 cycles

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Therapeutic Holiday

 September 2015 : Decision to start

therapeutic holiday with surveillance and MRI every 3 months.

 September 2016 :Maintained stable disease  MRI every 6

months.

 September 2017 : memory trouble

 MRI demonstrated increased contrast enhancement in the frontal lesion.

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Third Relapse

 October 2017: status epilepticus

– MRI :

• an increased leptomeningeal contrast

enhancement as well as in the superior region of the frontal lobe.

– Surgery was revoked due to the multifocality of the lesions. – Admission to the critical care facility. – Right hemiplegia with conscience problems. – Improved conscience with adjustment of antiepileptic drugs.

 Rechallenge with Bevacizumab 15mg/kg every

3 weeks

– After two cycles in January 2018 : Persistent hemiplegia but improved clinical status with decreased contrast enhancement on MRI.

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