Demonstrating the clinical benefit of carboplatin and bevacizumab for the treatment of recurrent low-grade and anaplastic supratentorial, infratentorial and spinal cord ependymoma in a multi-center Phase II trial using patient reported outcomes
Recommended Citation
Mendoza T, Omuro A, Yuan Y, Vera E, Wall K, Grajkowska E, Reyes J, Penas-Prado M, Walbert T, Mikkelsen T, Weathers S, O’Brien B, DeGroot J, Puduvalli V, Pentsova E, DeAngelis L, Kaley T, Gavrilovic I, Batchelor T, Gilbert M, Armstrong T. Demonstrating the clinical benefit of carboplatin and bevacizumab for the treatment of recurrent low-grade and anaplastic supratentorial, infratentorial and spinal cord ependymoma in a multi-center Phase II trial using patient reported outcomes. Qual Life Res 2023; 32(2):S138-S139.
Document Type
Conference Proceeding
Publication Date
11-4-2023
Publication Title
Qual Life Res
Keywords
bevacizumab, carboplatin, adult, antiangiogenic therapy, brain tumor, cognition, cohort analysis, conference abstract, disease severity, drug therapy, ependymoma, female, human, male, multicenter study, nuclear magnetic resonance imaging, patient-reported outcome, phase 2 clinical trial, radiotherapy, side effect, special situation for pharmacovigilance, spinal cord, spine tumor, surgery, therapy
Abstract
Aims: Ependymoma is a rare tumor occurring in the brain or spine. Initial treatment and at recurrence often include surgery/ - radiation therapy with limited data supporting the use of chemotherapy. In this multi-center study bevacizumab, a tumor starving or antiangiogenic therapy was combined with carboplatin, a cytotoxic chemotherapy, to test their efficacy in patients with recurrent ependymoma. As a secondary objective, we examined whether there are improvements in symptom severity and symptom interference in patients who responded to the therapy. Methods: Adult patients (n = 22) were enrolled and depending on tumor location, completed either the brain tumor (MDASI-BT) or spine (MDASI-SP) module of the MD Anderson Symptom Inventory at baseline, Cycle 2 and Cycle 4. We categorized patients either as a responder (stable/no disease progression) or non-responder (disease progression) based on MR imaging. We fitted regression lines over time to compare responders with non-responders in those with brain and spine tumors using scale factor scores and symptom interference. Positive slopes indicate worsening while negative slopes denote improvement. Results: Completion rates were 91%, 91% and 72% at baseline, cycle 2 and cycle 4, respectively. Brain tumor responders showed reduction while non-responders had an increase in both neurologic (slope = - 0.11 vs. 0.23; Fig. 1) and cognitive symptoms (slope = - 0.20 vs. 0.35; Fig. 2), with no differences in slopes noted between the groups for affective and treatment-related symptoms and both showing a reduction in general disease symptoms (slope = - 0.12 vs. - 0.16). Spine tumor responders and non-responders both showed worsening disease-related symptoms (slope = 0.39 vs. 0.25) with stable constitutional/ treatment-related symptoms in responders and worse emotional symptoms for non-responders. Activity-related interference worsened for both groups (brain and spine), whereas mood-related interference was stable in those with brain tumors. Conclusion: Collection of longitudinal disease was feasible and treatment-related symptom data in a multi-center study of a rare disease demonstrates differential effects in disease and mood-associated measures in brain tumor patients with similar treatment associated symptoms and worsened interference. These findings are consistent with the antiedema- related symptomatic benefit with bevacizumab in brain tumors but not spine tumors and cumulative effect of symptomatic toxicities on interference.
Volume
32
Issue
2
First Page
S138
Last Page
S139
