Hypoxia-activated evofosfamide for treatment of recurrent bevacizumab-refractory glioblastoma: A phase I surgical study

Andrew Brenner, Richard Zuniga, Jessica D. Sun, John Floyd, Charles P. Hart, Stew Kroll, Lisa Fichtel, David Cavazos, Laura Caflisch, Aleksandra Gruslova, Shiliang Huang, Yichu Liu, Alessia Lodi, Stefano Tiziani

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: Anti-angiogenic therapy is known to induce a greater degree of hypoxia, including in glioblastoma (GBM). Evofosfamide (Evo) is a hypoxia-activated prodrug which is reduced, leading to the release of the alkylating agent bromo-isophosphoramide mustard. We assessed the safety, tolerability, preliminary efficacy, and biomarkers of Evo plus bevacizumab (Bev) in Bev-refractory GBM. Methods: Twenty-eight patients with Bev-refractory GBM were enrolled in a dose escalation study receiving from 240 mg/m2 (cohort 1) to 670 mg/m2 (cohort 4) of Evo every 2 weeks in combination with Bev. Patients deemed surgical candidates underwent a single dose of Evo or placebo with pimonidazole immediately prior to surgery for biomarker evaluation, followed by dose escalation upon recovery. Assessments included adverse events, response, and survival. Results: Evo plus Bev was well tolerated up to and including the maximum dose of 670 mg/m2, which was determined to be the recommended phase II dose. Overall response rate was 17.4%, with disease control (complete response, partial response, and stable disease) observed in 14 (60.9%) of the 23 patients.The ratio of enhancement to non-enhancement was significant on log-rank analysis with time to progression (P = 0.023), with patients having a ratio of less than 0.37 showing a median progression-free survival of 98 days versus 56 days for those with more enhancement. Conclusions: Evo plus Bev was well tolerated in patients with Bev-refractory GBM, with preliminary evidence of activity that merits further investigation.

Original languageEnglish (US)
Pages (from-to)1231-1239
Number of pages9
Issue number9
StatePublished - Aug 2 2018


  • Bevacizumab
  • Evofosfamide
  • Glioblastoma
  • Hypoxia
  • Recurrence

ASJC Scopus subject areas

  • Clinical Neurology
  • Oncology
  • Cancer Research


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