INTRODUCTION First-line bevacizumab (BEV) is now available as a treatment option for glioblastoma patients with severe clinical conditions in Japan. However, the survival benefits remain controversial. To elucidate these potential survival benefits, we retrospectively analyzed survival in glioblastoma patients receiving BEV. METHODS We analyzed survival in 120 patients with IDH-wild type glioblastoma treated from 2002 to 2018. Overall survival (OS) was assessed in three treatment era subgroups [pre-temozolomide (TMZ), TMZ, and TMZ-BEV], and the correlations of prognostic factors with survival were evaluated. RESULTS An improvement in survival was observed after BEV approval (median OS in the pre-TMZ, TMZ, and TMZ-BEV eras: 14.6, 14.9, and 22.1 months, respectively). A Cox proportional hazards model identified extent of resection and MGMT methylation status as significant prognostic factors in the TMZ era; however, these factors were not significant in the TMZ-BEV era. In subgroup analyses, patients with MGMT methylation had improved OS after TMZ introduction (pre-TMZ vs. TMZ, 18.5 vs. 28.1 months; P = 0.13), and those without MGMT methylation had significantly increased OS after BEV approval (TMZ vs. TMZ-BEV, 12.2 vs. 16.7 months; P = 0.04). CONCLUSIONS Our findings imply that optional first-line administration of BEV can overcome the impact of conventional risk factors and prolong survival complementary to TMZ. The patient subgroups benefitting from TMZ and BEV did not seem to overlap, and stratification based on risk factors, including MGMT methylation status, might be effective for selecting patients in whom BEV should be preferentially used as a first-line therapy.

中文翻译：

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一线贝伐单抗有助于替莫唑胺补充胶质母细胞瘤患者的生存。

简介在日本，一线贝伐单抗（BEV）现在可作为胶质母细胞瘤患者的临床治疗方法。然而，生存利益仍存在争议。为了阐明这些潜在的生存优势，我们回顾性分析了接受BEV的胶质母细胞瘤患者的生存情况。方法我们分析了2002年至2018年治疗的120例IDH野生型胶质母细胞瘤患者的生存情况。评估了三个治疗时代亚组的整体生存（OS）：替莫洛米特（TMZ），TMZ和TMZ-BEV及其相关性评价具有生存率的预后因素。结果获得BEV批准后，观察到生存率有所改善（TMZ之前，TMZ和TMZ-BEV时代的中位OS分别为14.6、14.9和22.1个月）。Cox比例风险模型将切除范围和MGMT甲基化状态确定为TMZ时代的重要预后因素；但是，这些因素在TMZ-BEV时代并不重要。在亚组分析中，TMZ引入后，MGMT甲基化的患者的OS改善（TMZ之前为TMZ，TMZ之前为18.5 VS.28.1个月； P = 0.13），BEV批准后，没有MGMT甲基化的患者OS显着增加（TMZ vs. TMZ -BEV，12.2个月和16.7个月； P = 0.04）。结论我们的研究结果表明，可选的一线BEV给药可以克服常规危险因素的影响并延长TMZ的生存期。受益于TMZ和BEV的患者亚组似乎没有重叠，并且基于风险因素（包括MGMT甲基化状态，