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The early initial progression, occurring shortly after
the second adjuvant temozolomide cycle, made us
consider a scheme that could achieve a high rate of
disease control. The outstanding response obtained
at 4 months of treatment with fotemustine plus
bevacizumab, without radiological evidence from the
pre-existing tumor mass, prompted us to continue with
[12]
bevacizumab maintenance. When this patient had
received temozolomide monotherapy, he presented
with instability and vertiginous symptoms. During
a b
bevacizumab and fotemustine therapy, the neurological
Figure 1: (a) Magnetic resonance imaging 3 months after fi nishing radiotherapy symptoms disappeared. The withdrawal of bevacizumab
during temozolomide monotherapy; (b) response after two cycles of
fotemustine and bevacizumab treatment after 7 months of treatment, due to pulmonary
thromboembolism, caused a relapse of the disease.
In April 2012, pulmonary thromboembolism occurred, Nonetheless, the patient achieved stabilization of the
and the bevacizumab was withdrawn. Low molecular disease from reintroduction of fotemustine until his death
weight heparin treatment was initiated. Two months due to thromboembolic and infectious complications.
later, repeat MRI showed a 2.5 cm enhancement area We consider this case interesting because treatment with
in the surgical site, suggesting tumor relapse. In June bevacizumab plus fotemustine achieved rapid response,
2012, fotemustine was restarted as monotherapy at in 4 months, in a patient with rapid progression to
2
75 mg/m every 3 weeks (two cycles). In August 2012, fi rst-line treatment. Furthermore, it is notable because
MRI showed tumor stabilization. In November 2012, the the patient responded to treatment with fotemustine after
patient suffered bronchoaspiration and unfortunately died. the progression that occurred following withdrawal of
bevacizumab maintenance.
Discussion
We consider that this combination scheme should be
Fotemustine is a third-generation nitrosourea with alkylating tested in further clinical trials. Due to the promising
cytotoxic activity and high lipophilicity that allows it to results reported by Soffi etti et al., and confi rmed by
cross the blood-brain barrier. It achieves therapeutic levels our own clinical experience, fotemustine should be
in the CNS and has proven antitumor activity, either as considered as rescue treatment for relapsed GBM.
monotherapy or in combination. [5,8-10] Bevacizumab is a
humanized monoclonal antibody that inhibits vascular References
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2
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Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦ 37