Postoperative concurrent chemoradiotherapy plus apatinib for patients with high-grade glioma: a retrospective cohort study

Radiotherapy plus temozolomide followed by adjuvant temozolomide was the standard treatment for high-grade gliomas. This study aimed to explore the effectiveness and safety of the addition of apatinib in patients with high-grade gliomas after surgery. In this retrospective cohort study, patients with high-grade glioma [World Health Organization (WHO) grade III or IV] treated with apatinib and concurrent chemoradiotherapy (cCRT) after surgery from October 2017 to February 2021 were reviewed. High-grade glioma patients used cCRT alone in the same period were reviewed as the control group. Progression-free survival (PFS), overall survival (OS), the grade of peritumoral brain edema (PTBE) and safety profiles were recorded. Cox regression analyses were used to determine the associated factors of PFS and OS. A total of 60 patients with high-grade glioma were reviewed, with 30 patients in the apatinib plus cCRT group and 30 patients in the cCRT group. The median PFS of the apatinib plus cCRT group compared with the cCRT group was 8.53 vs. 7.33 months (P=0.62), and the median OS was 13.70 vs. 14.30 months (P=0.93). Multivariate analysis revealed that only pathological grade was independently associated with PFS [hazard ratio (HR) =4.445, 95% confidence interval (CI): 1.857 to 10.641, P<0.001] and OS (HR =3.737, 95% CI: 1.530 to 9.123, P=0.004). The apatinib plus cCRT also improved PTBE (P=0.001), and decrease the corticosteroids use than cCRT alone (P=0.002). No grade 3 or higher adverse event was observed in both groups. Post-operative cCRT plus apatinib was feasible for patients with high-grade glioma, with manageable toxicities.