Corticosteroid Use in Patients with Glioblastoma at First or Second Relapse Treated with Bevacizumab in the BRAIN Study

Background. Vascular endothelial growth factor inhibitors have corticosteroid‐sparing effects in patients with high‐grade gliomas. We assessed corticosteroid use in patients with recurrent glioblastoma treated with bevacizumab (BEV) in the BRAIN study (J Clin Oncol 2009;27:4733–4740). Methods. BRAIN was a phase II, multicenter, randomized, noncomparative trial of BEV alone (n = 85) or in combination with irinotecan (CPT‐11) (n = 82) in adults with recurrent glioblastoma. Median corticosteroid dose for patients who used corticosteroids at baseline was summarized by treatment arm; the percentage of patients who had sustained (≥50% corticosteroid dose reduction for ≥50% of time on study drug) or complete (discontinuation of corticosteroid for ≥25% of time on study drug) reduction in corticosteroid dose overall and by objective response and progression‐free survival was calculated. The incidence of corticosteroid‐related adverse events was summarized. Results. In each treatment group, 50% of patients were using systemic corticosteroids at baseline. The majority of those experienced a reduction in dose while receiving BEV‐based therapy. Thirteen (30.2%) BEV and 20 (46.5%) BEV + CPT‐11 patients had a sustained reduction of corticosteroid dose; 7 (16.3%) BEV and 9 (20.9%) BEV + CPT‐11 patients had a complete reduction of corticosteroid dose. The majority of patients who had an objective response or progression‐free survival >6 months experienced corticosteroid dose reduction. Approximately 64% of patients who used corticosteroids while receiving BEV‐based therapy experienced infection. Conclusion. BEV may have corticosteroid‐sparing effects in patients with recurrent glioblastoma. Corticosteroid reduction may positively affect patient health‐related quality of life. Given the exploratory nature of the analyses in a noncomparative study, these results should be interpreted cautiously. Vascular endothelial growth factor inhibitors have corticosteroid‐sparing effects in patients with high‐grade gliomas. Bevacizumab may have corticosteroid‐sparing effects, and corticosteroid use over time while receiving bevacizumab should be systematically evaluated, and dose should be decreased as tolerated by the patient. Corticosteroid reduction may positively affect patient health‐related quality of life.