We commend Iwamoto et al. for their article regarding patterns of relapse and survival in patients treated with bevacizumab (BEV) for recurrent glioblastoma (GBM).The authors reported on patterns of relapse in 37 adult patients with recurrent GBM treated with BEV. Forty-three percent of patients were treated with BEV plus irinotecan and 38% were treated with BEV plus hypofractionated radiotherapy. The pattern of recurrence prior to BEV-based therapy was not reported. Following progression on BEV and discontinuance of BEV, 35% of patients demonstrated nonenhancing tumor progression, 16% had multifo-cal disease progression, and 46% had local recurrence. Median survival in patients (19/37) receiving salvage therapy after progression on BEV was 5.2 months compared to 2.0 median survival in patients receiving no further therapy and only supportive care. The survival in patients treated after BEV progression in this report contradicts other data that have shown a median survival of 3 months, which is significant with respect to trial design for patients progressing on BEV.
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