The role of the development of hypertension or proteinuria in predicting outcome with the use of bevacizumab for patients with glioblastoma multiforme (GBM).

2021 Background: Antiangiogenic therapy using bevacizumab has become the standard of care for managing GBM patients with recurrent disease. Hypertension and proteinuria commonly encountered in patients receiving bevacizumab may predict therapeutic benefit from bevacizumab therapy Methods: Between 2005 and 2010, 166 patients with histologically proven glioblastoma who had received bevacizumab were eligible for this retrospective analysis. Data collection included demographics, blood pressure, urinary protein, brain MRI, progression-free survival and overall survival after initiation of bevacizumab-containing regimens. Results: See table. Of these, 120 patients (75%) developed hypertension. This correlated to a statistically significant increase in both median PFS (7.0 vs. 2.9 months, p<0.001) and OS (11.7 vs. 5.7 months, p<0.001) in comparison to normotensive patients. A statistically significant increase in both PFS (7.1 vs. 6.0 months, p=0.002) and OS (13.2 vs. 9.3 months, p=0.008) were also observed in 65 patients (39%) who developed proteinuria. Conclusions: Much higher incidences of hypertension and proteinuria have been observed from bevacizumab-treated patients with GBM than those reported in solid tumors. Both hypertension and proteinuria developed from bevacizumab therapy were correlated to prolonged PFS and OS. Prospective validating these markers in predicting therapeutic benefit of antiangiogenic agent may be built into future clinical trials. Overall survival Progression-free survival Variable N Median survival time (months) (95% CI) P value (adjusted p value) Median survival time (months) (95% CI) P value (adjusted p value) Protein Yes 65 13.2 (10.7, 16.7) 0.008 (0.001) 7.1 (5.7, 10.4) 0.002 (0.006) Urea No 101 9.3 (7.6, 10.5) 6.0 (4.4, 7.4) Hypertension status HTN 120 11.7 (9.3, 12.5) HTN vs. Pre 0.134 (0.027) HTN vs. N 0.0004 (<0.001) Pre vs. N 0.068 (0.039) 7.0 (5.5, 8.3) HTN vs. Pre 0.565 (0.207) HTN vs. N <0.001 (<0.001) Pre vs. N 0.036 (0.009) Pre-HTN 27 8.9 (3.7, 12.3) 6.0 (3.2, 7.4) Normal 14 5.7 (1.1, 10.8) 2.9 (1.1, 5.6)