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Bumes E, Rzonsa S, Hutterer M, Proescholdt M, Bogdahn U, Riemenschneider MJ, Uhl M, Wendl C, Hau P. Adverse event grading following CTCAE v3.0 underestimates hypertensive side effects in patients with glioma treated with Bevacizumab. J Neurooncol 2016; 127:191-200. [PMID: 26721240 DOI: 10.1007/s11060-015-2031-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
Anti-VEGF therapy with Bevacizumab (BEV) is widely used in cases of relapsed high-grade glioma (HGG). Arterial hypertension is a known side effect of anti-VEGF therapy. 42 Patients with relapsed HGG were treated with BEV 10 mg/kg on days 1 and 15 of 28-day cycles in addition to treatment with 40 mg TMZ daily until disease progression, based on magnetic resonance imaging and/or worsening of clinical status. In a retrospective analysis, hypertensive side effects were evaluated as the primary endpoint, while survival information in addition to toxicity was analyzed as secondary endpoint. Grading which employs the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 detected hypertensive events with a significantly higher sensitivity than CTCAE version 3.0. The rate of severe hypertensive events observed as CTCAE ≥ °3 were 9.5 % in version 3.0 and 45.2 % in version 4.0. The results presented here indicate that CTCAE version 3.0 may underreport the incidence and grade of BEV-induced hypertension within clinical trials. As hypertension has not only long-term, but also severe short-term side effects, we suggest that arterial hypertension under BEV should be scored according to CTCAE version 4.0 to avoid clinically relevant hypertension-related adverse events in these patients.
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Affiliation(s)
- Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Sarah Rzonsa
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Markus Hutterer
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Markus J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Martin Uhl
- Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christina Wendl
- Department of Radiology, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany.
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