Rechallenging Recurrent Glioblastoma with Intra-Arterial Bevacizumab with Blood Brain Barrier Disruption Results in Radiographic Response: a Case Report

Abstract Background High dose bevacizumab delivered via super selective intra-arterial cerebral infusion (SIACI) is one promising clinical trial combination for patients with glioblastoma (GBM). While both continuous intravenous and intraarterial administration of bevacizumab, and rechallenge with intravenous bevacizumab, have demonstrated improved survival, this is the first description of rechallenging GBM with SIACI of bevacizumab. Case Description We report a case of a 43-year-old female with recurrent glioblastoma who has received treatment from three clinical trials, including a re-challenge with SIACI of bevacizumab. First, she enrolled into a phase I/II trial for patients newly diagnosed with GBM (BLINDED FOR REVIEW) and received three doses of SIACI bevacizumab over 180 days in addition to standard of care chemotherapy and radiation. Following progression indicated on her MRI, she consented for a separate clinical trial for her disease and received two cycles of temozolomide with an investigational agent. The patient was removed from the study upon tumor progression. Subsequently, she was rechallenged with SIACI of bevacizumab via a third clinical trial (BLINDED FOR REVIEW) and then completed three intravenous infusions. After completing the third trial, her MRI demonstrated improvement based on RANO criteria. Conclusions This is the first report to highlight the effect of rechallenging a patient with SIACI of bevacizumab following disease progression after initial bevacizumab treatment and subsequent alternate clinical trial failure. There is a need to conduct further clinical trials to evaluate the benefits of rechallenge with SIACI versus IV bevacizumab for GBM, further exploring theories of bevacizumab resistance.