Salvage therapies for recurrent grade 4 IDH-wildtype glioma: a BRAIN Registry analysis of real-world treatment patterns

Abstract

Purpose The prognosis for patients with glioblastoma after failure of first-line therapy is poor. Despite this, the standard of care for patients with recurrent disease is not well-defined. Here we report on the use of salvage therapies in glioblastoma using real-world data.

Methods Data were extracted from the BRAIN Registry for patients diagnosed with glioblastoma (Grade 4, IDH wild-type) between 09/2019 and 01/2024. Only patients who received salvage therapies following a documented date of recurrence/progression were included. Relevant descriptive and intergroup statistics were used, with survival calculated using Kaplan-Meier and Cox regression used for multivariate analyses.

Results 275 patients were identified. Median age was 61 (range:23–88) years, with 56% being ECOG 0–1 at recurrence. Median time to progression was 7.6 months with 65% recurring/progressing during first-line therapy. Systemic therapy (85%) was most utilised with 67% receiving single-agent bevacizumab. Outcomes in this subgroup were similar to clinical trial data. 29% patients underwent re-resection with 58% of these then receiving systemic treatment. Compared with no surgery, patients who underwent re-resection were younger (p = 0.02), of better performance status (p = 0.006) and more likely to have recurred post completing first-line therapy (p = 0.001). Few patients (n = 9) received re-irradiation with median of 15 months between radiation events. Median post-progression survival (PPS) was 9.5 months. After adjustment for confounders, there was no difference in PPS for patients who underwent re-resection versus systemic therapy alone (p = 0.242). The survival differences observed between treatment modalities likely reflect patient factors influencing treatment selection and were impacted by small subgroup sizes.

Conclusion Systemic therapy is most utilised in the salvage setting, predominantly bevacizumab. Certain patient characteristics were associated with re-resection. Re-irradiation was rarely used.