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Case Report

Complete response with fotemustine and bevacizumab after early
progression following radiotherapy and temozolomide treatment in
patient with glioblastoma multiforme

Ovidio Fernández Calvo, María Eva Pérez López, Jesús García Gómez
Department of Medical Oncology, Ourense University Hospital, 32005 Ourense, Spain.
Correspondence to: Dr. Ovidio Fernández Calvo, Department of Medical Oncology, Ourense University Hospital, 54 Ramon Puga Street, 32005
Ourense, Spain. E-mail: ovidiofernandezcalvo@yahoo.es

ABSTRACT
Glioblastoma multiforme is the most common type of primary central nervous system tumor and is noted for its short survival
and poor response to chemotherapeutic agents. Unfortunately, the relapse rate is very high, and there is no reference drug for
second-line treatment. In this study, a patient was treated with the Soffi etti regimen. The induction phase was fotemustine 75 mg/m
2
at day 1 and day 8 and bevacizumab 10 mg/kg at day 1 and day 15. The maintenance phase was fotemustine 75 mg/m and
2
bevacizumab 10 mg/kg every 3 weeks for two cycles. Follow-up magnetic resonance imaging showed post-surgical changes at
the left occipital level, without contrast enhancement, and toxic left leuko-encephalopathy post-treatment without mass effect and
with no evidence of tumor residue. The patient then was maintained with bevacizumab monotherapy until it was withdrawn when
pulmonary thromboembolism occurred. Following tumor regrowth, fotemustine was started again as maintenance therapy. The
patient achieved stabilization of his disease until his death due to thromboembolic and infectious complications.
Key words: Bevacizumab, brain tumor, fotemustine

Introduction was diagnosed as a WHO grade 4 GBM, with a 30%
mind bomb E3 ubiquitin-ligase 1 proliferation index.
Glioblastoma multiforme (GBM) is the most common
type of primary central nervous system (CNS) tumor In March 2011, external radiotherapy (total dose
and is noted for its short survival and poor response 60 Gy, fractioned in 2 Gy/day) was started with
to chemotherapeutic agents. Adjuvant temozolomide concomitant temozolomide at 75 mg/m /day, followed by
[1]
2
and radiotherapy is the gold-standard treatment. temozolomide monotherapy (150 mg/m for 5 days each
[2]
2
2
Unfortunately, the relapse rate is very high, and there is 28 day circle in the fi rst cycle, and 200 mg/m in the
no reference drug for second-line treatment. [3-5] second cycle). Thereafter, an episode of gait imbalance
with motor disturbance of the right upper limb occurred.
Case Report
Three months after fi nishing radiotherapy, a brain MRI
This report describes the case of a 58-year-old patient showed a cystic left parieto-occipital lesion measuring
with a history of hypertriglyceridemia and psoriasis 40 mm × 40 mm × 30 mm, and edema. This MRI
who was admitted to the emergency department after suggested tumor relapse [Figure 1a].
a 4-day episode of disorientation to time and place,
speech disturbance, 2/5 lack of muscle strength, The patient rejected surgery and chemotherapy according
[6]
right hemi-temporal blindness, and motor dysphasia. to the Soffi etti et al. regimen was started. The induction
2
Chest, abdominal, and pelvic computed tomography phase was fotemustine 75 mg/m at day 1 and day 8 and
was unremarkable. A brain magnetic resonance bevacizumab 10 mg/kg at day 1 and day 15, followed by
imaging (MRI) showed an oval left parieto-occipital an interval of 3 weeks, and maintenance phase: fotemustine
2
lesion with the anteroposterior diameter of 27 mm, 75 mg/m and bevacizumab 10 mg/kg, every 3 weeks for
nodular contrast medium enhancement and white matter two cycles. Follow-up MRI showed post-surgical changes at
edema. In February 2011, the lesion was resected and the left occipital level, without contrast enhancement, toxic
left leuko-encephalopathy post-treatment, without mass
effect and with no evidence of tumor residue [Figure 1b].
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There was a clinical response and from a radiological
Quick Response Code: point of view, the mass had disappeared and there was
Website:
www.jcmtjournal.com no contrast enhancement (Response Assessment in
Neuro-Oncology criteria were used to assess this). The
[7]
patient was discharged on a physiological replacement
DOI:
10.4103/2394-4722.153446 dose of corticosteroids and maintenance bevacizumab
monotherapy.
36 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦