Real-World Outcomes of Irinotecan–Bevacizumab Therapy in Recurrent Brain Tumors: A Retrospective Cohort Study

Seyyar M., Şancı P. C., kalem a., METE B., KÖŞECİ T., Karakayalı A., ...Daha Fazla

Çukurova Anestezi ve Cerrahi Bilimler Dergisi, cilt.9, sa.1, ss.132-137, 2026 (TRDizin)

Özet

Aim: Although the irinotecan–bevacizumab (IB) combination is a frequently used treatment option for recurrent high-grade gliomas, predominantly glioblastoma multiforme and other brain tumors, clinical benefit shows heter- ogeneity among patients. This study aimed to evaluate clinical and prognostic factors associated with early-stage mortality and overall survival (OS) in patients receiving IB therapy. Methods: Seventy-eight brain tumor patients who received IB treatment between 2015 and 2023 were retrospec- tively evaluated. The demographic, clinical, and pathological characteristics of the patients were recorded. The timing of IB treatment initiation was categorized according to whether it was started at the first recurrence or subsequent recurrences. Factors associated with early period mortality (≤6 months, defined based on the median survival observed in prior IB studies and consistent with benchmark thresholds used in recurrent glioma trials) were determined using log-linear regression analysis, while independent prognostic factors affecting OS were determined using the Cox proportional hazards regression model. Results: The mean age of the patients was 53.01±12.78 years, and the mean follow-up period was 9.47 months. The mortality rate within the first 6 months was found to be 44.9%. Early period mortality was significantly asso- ciated with multilobular tumor localization (p = 0.037) and initiation of IB treatment at the ≥2nd recurrence (p=0.036). According to log-linear regression analysis, the probability of survival beyond 6 months was approxi- mately 80% lower in patients with multilobular tumor localization (RR=0.198, 95% CI: 0.054–0.735). In patients who started IB therapy at ≥2nd recurrence, this probability was reduced by approximately 77% (RR=0.227, 95% CI: 0.069–0.748). In the multivariate Cox regression analysis, starting IB at ≥2nd relapse (HR: 2.35, 95% CI: 1.09– 5.07, p=0.029), the presence of an IDH mutation (HR: 1.98, 95% CI: 1.09–3.58, p=0.025), and age (HR: 1.03, 95% CI: 1.01–1.05, p=0.015) were identified as independent prognostic factors for OS. Conclusions: This retrospective real-world cohort study demonstrates that the clinical benefit of the IB combina- tion varies according to patient subgroups. Multilobar involvement and initiation of IB therapy at a late line are associated with early mortality and poor survival.