INNV-63. Temporal optimization of the Stupp Protocol- Proper Use of Salvage Therapy including Bevacizumab significantly enhances survival and quality of life
Year: 2025
Type: conference-abstract
Abstract: We examined therapies that extend life after use of the Stupp protocol and their patient selection biases. There is a focus on the use of Bevacizumab to aid completion of the Stupp protocol, and the optimization of salvage strategies, re-resection, re-irradiation and use of B/CCNU chemotherapeutics. The cohort of 269 was selected from patients harvested by our data support team, winnowed down to those who met the WHO’s 2021 glioblastoma definition and a full patient record. Physical condition, not patient age, should dictate aggressiveness of treatment. Even if patients fail and cannot complete Stupp, there is a clear benefit to pursuing these salvage therapies. Salvage normally occurs after MRI scans indicate progression. However, when clinicians deem radiological abnormalities as pseudoprogression and continue the Stupp protocol, we observe a statistically significant improvement in patient outcome, with doubling of survival in a number of patient subgroups. Dexamethasone levels greatly impact patient outcomes including when used with salvage therapies, and must be lowered in critical time periods. Bevacizumab infusion drops dexamethasone-dependency from 2.2 mg/m2 to <0.6 mg/m2, p<0.0001. Bevacizumab has its greatest impact on patient outcome when used during treatment with temozolomide, both during chemoradiation and/or adjuvant temozolomide cycles. Patients who progress prior to completing chemoradiation or 6-cycles of adjuvant chemotherapy, or the appearance of a new, satellite lesion, are best treated with a second resection or reirradiation, p<0.02 unmethylated. We find no clear temporal signature for the use of B/CCNU or reradiation. There is an exquisite impact of patient dexamethasone levels prior to treatment with B/CCNU or reradiation and outcomes. Before the initiation of B/CCNU or irradiation, dexamethasone levels need to be below a critical threshold of 1.2 mg/m².
Source: Neuro-Oncology
Authors: David Baskin, Alexandra Baskin, Martyn Sharpe
Institution: Houston Methodist
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4416140662
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