Long-Term Survival Outcomes of Hypofractionated Stereotactic Radiotherapy Combined with Anlotinib for Recurrent Glioblastoma: An Extended Follow-up Report
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v7i2.5293
Abstract
Background: The clinical management of recurrent glioblastoma (rGBM) is highly challenging. We previously reported the preliminary safety and efficacy of hypofractionated stereotactic radiotherapy (HSRT) combined with anlotinib for rGBM. This brief report provides an extended long-term follow-up of this cohort to evaluate survival outcomes and late toxicities. Methods: The original cohort of five patients treated with HSRT (25.0 Gy in 5 fractions) and concurrent/adjuvant anlotinib (12 mg daily, days 1–14 every 3 weeks) was retrospectively analyzed for long-term progression-free survival (PFS), overall survival (OS), and late adverse events. Results: Over a significantly extended observation period, the updated median PFS was 9.9 months, and the median OS reached an encouraging 29.1 months. At the latest follow-up, two patients had experienced in-field disease progression and died, while one patient died from a cerebral infarction. Two patients were alive at their last clinical contact, and their robust survival times were appropriately right-censored at 42.1+ and 46.8+ months post-treatment, respectively. No severe late radiation necrosis (grade ≥ 3) or uncontrollable targeted-therapy toxicities were observed. Conclusion: The extended follow-up confirms that HSRT combined with anlotinib provides a durable clinical response and a highly meaningful long-term survival benefit for select patients with rGBM, maintaining a favorable long-term safety profile.
Keywords
glioblastoma, CyberKnife, anlotinib, bevacizumab, anti-VEGF
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[2]Sneed PK, Gutin PH, Larson DA, et al. Patterns of Recurrence of Glioblastoma Multiforme after External Irradiation Followed by Implant Boost. Int J Radiat Oncol Biol Phys. 1994;29(4):719-727.
[3]Wong ET, Gautam S, Malchow C, et al. Bevacizumab for Recurrent Glioblastoma Multiforme: A Meta-Analysis. J Natl Compr Canc Netw. 2011;9(4):403-407.
[4]Wick W, Gorlia T, Bendszus M, et al. Lomustine and Bevacizumab in Progressive Glioblastoma. N Engl J Med. 2017;377(20):1954-1963.
[5]Shen G, Zheng F, Ren D, et al. Anlotinib: A Novel Multi-Targeting Tyrosine Kinase Inhibitor in Clinical Development. J Hematol Oncol. 2018;11(1):120.
[6]Lv Y, Zhang J, Liu E, et al. Targeted Therapy with Anlotinib for Patient with Recurrent Glioblastoma: A Case Report and Literature Review. Medicine (Baltimore). 2019;98(22):e15749.
[7]Wang Y, Liang D, Chen J, et al. Targeted Therapy with Anlotinib for a Patient with an Oncogenic FGFR3-TACC3 Fusion and Recurrent Glioblastoma. Oncologist. 2021;26(3):173-177.
[8]Guan Y, Li J, Gong X, et al. Safety and Efficacy of Hypofractionated Stereotactic Radiotherapy with Anlotinib Targeted Therapy for Glioblastoma at the First Recurrence: A Preliminary Report. Brain Sci. 2022;12:471.
[9]Vredenburgh JJ, Desjardins A, Herndon JE, et al. Bevacizumab plus Irinotecan in Recurrent Glioblastoma Multiforme. J Clin Oncol. 2007;25(30):4722-4729.
[10]Friedman HS, Prados MD, Wen PY, et al. Bevacizumab Alone and in Combination with Irinotecan in Recurrent Glioblastoma. J Clin Oncol. 2009;27(28):4733-4740.
[11]Sorensen AG, Batchelor TT, Zhang WT, et al. A "Vascular Normalization Index" as Potential Mechanistic Biomarker to Predict Survival after a Single Dose of Cediranib in Recurrent Glioblastoma Patients. Cancer Res. 2009;69(13):5296-5300.
[12]Tsien C, Pugh S, Dicker AP, et al. Reirradiation and Concurrent Bevacizumab versus Bevacizumab Alone as Treatment for Recurrent Glioblastoma: NRG Oncology/RTOG 1205. J Clin Oncol. 2023;41(6):1285-1295.
[13]Gutin PH, Iwamoto FM, Beal K, et al. Safety and Efficacy of Bevacizumab with Hypofractionated Stereotactic Irradiation for Recurrent Malignant Gliomas. Int J Radiat Oncol Biol Phys. 2009;75(1):156-163.
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