Prognostic value of hypertension timing for survival in glioblastoma patients receiving bevacizumab: a retrospective single centre analysis.

Introduction: Hypertension, the most common adverse events associated with bevacizumab (BEV) treatment, has been proposed as a potential biomarker of treatment response in glioblastoma (GBM) patients. This study aimed to evaluate whether the timing of hypertension serves as a prognostic value in GBM patients.

Methods: This retrospective study consisting of 56 GBM patients treated with initial BEV between 2013 and 2024. Blood pressure was monitored peri-infusion of BEV (before and 60 min after). Patients were grouped into normotension, pre-existing hypertension (before first BEV infusion), and BEV-induced hypertension, further classified as early new-onset (≤ 3 cycles) or late-onset (> 3 cycles). Overall survival (OS) was assessed using the Kaplan-Meier method.

Results: Fifteen (36.6%) patients had pre-existing hypertension, while 26 (63.4%) were normotensive at baseline. Among the normotensive patients, twelve (46.1%) developed early new-onset hypertension, and 13 (50%) developed late-onset hypertension. Patients with pre-existing hypertension demonstrated significantly longer median OS compared to normotensive patients (32 vs. 22 months, p = 0.043). Early new-onset hypertension was also associated with improved OS compared to patients who remained normotensive after three cycles (25 vs. 16 months, p = 0.003). Additionally, patients with pre-existing and early new-onset hypertension showed longer OS compared to those with late-onset hypertension (25 vs. 14 months, p = 0.002).

Conclusion: Monitoring blood pressure during peri-infusion of BEV could be useful in predicting treatment response for GBM patients. Pre-existing or early new-onset hypertension is associated with improved survival, suggesting that timing of hypertension has a potential role as a biomarker for BEV efficacy.