Clinical benefit in recurrent glioblastoma from adjuvant NovoTTF-100A and TCCC after temozolomide and bevacizumab failure: a preliminary observation.
Bottom Line: The NovoTTF-100A is a device that emits alternating electric fields and it is approved for the treatment of recurrent glioblastoma.We treated a series of patients with NovoTTF-100A and bevacizumab alone (n = 34) or in combination with a regimen consisting of 6-thioguanine, lomustine, capecitabine, and celecoxib (TCCC) (n = 3).These observations illustrate the possibility of improving survival and achieving a response in patients with end-stage recurrent glioblastoma by biasing the tumor toward anti-tumor immunologic response with a combination of NovoTTF-100A and TCCC, as well as the continuation of bevacizumab in order to limit dexamethasone use due to its global immunosuppressive effect on the patient.
Affiliation: Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.Show MeSH
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Mentions: The OS of individual patients, their median daily dexamethasone usage, and their tumor size. (A) Waterfall plot of the OS of individual patients indicating that our three patients treated with NovoTTF-100A, bevacizumab, and TCCC all lived longer than the average. There was a trend suggesting that the median OS of these three patients, 10.3 (range 7.7–13.6) months, was longer than the median OS of the cohort treated with only NovoTTF-100A and bevacizumab, 4.1 (range 0.3–22.7) months (P = 0.0951). (B) The median daily dexamethasone dose between these two cohort did not differ, 2.8 (range 2.1–3.8) and 3.0 (0.0–15.0) mg, respectively (P = 0.8894). (C) Although the number in the cohort treated with NovoTTF-100A, bevacizumab, and TCCC is small in comparison with that treated with only NovoTTF-100A and bevacizumab, there does not appear to have a difference between the median tumor size in the two groups. Waterfall plot of the tumor size as measured by T1-weighted gadolinium-enhanced (T1Gad) MRI, median size 7.3 (7.0–23.3) versus 12.2 (0.3–40.6) cm2, respectively (P = 0.7809). (D) Waterfall plot of the tumor size as measured by fluid attenuated inversion recovery (FLAIR) MRI, median size 21.5 (11.9–53.8) versus 35.2 (7.0–90.9) cm2, respectively (P = 0.5043). Patients 1, 2, and 3 correspond to the MRI images displayed in Figures2, 3, and 4, respectively.
Affiliation: Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.