Optimizing Patient Selection for Bevacizumab Plus Irinotecan in Recurrent High Grade Glioma: Superiority of the Neutrophil-to-Lymphocyte Ratio Over Other Systemic Inflammation Indices
Sibel Oyucu Orhan1, Bedrettin Orhan2, Ulviyya Hasanzade3, Seda Sali1, Burcu Caner4, Birol Ocak5, Ahmet Bilgehan Şahin6, Adem Deligönül6, Erdem Çubukçu6, Türkkan Evrensel61Department of Medical Oncology, Bursa City Hospital, Bursa, Türkiye, 2Department of Hematology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Türkiye, 3Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa, Türkiye, 4Department of Medical Oncology, Aydın Atatürk Public Hospital, Aydın, Türkiye, 5Department of Medical Oncology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Türkiye, 6Department of Medical Oncology, Faculty of Medicine, Bursa Uludag University, Bursa, Türkiye
Objectives: Recurrent high-grade gliomas (rHGG) pose a significant challenge with poor prognosis. While bevacizumab plus irinotecan (BEV+IRI) is a frequent salvage regimen, clinical outcomes exhibit substantial inter-patient heterogeneity. Therefore, accessible prognostic biomarkers are needed to identify patients most likely to benefit. Methods: This retrospective, single-center study enrolled adults with recurrent WHO grade 3–4 gliomas treated with BEV+IRI. Pre-treatment laboratory data were used to calculate Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), Pan-Immune-Inflammation Value (PIV), and hemoglobin, albumin, lymphocyte, platelet (HALP) scores. Optimal cut-offs were determined via receiver operating characteristics (ROC) analysis. Survival was analyzed using Kaplan-Meier and Cox regression models. Results: In 43 patients, median overall survival (OS) was 9.6 months; median progression free survival (PFS) was 5.8 months. Patients with high pre-treatment NLR (?6.74) had significantly shorter OS (4.4 vs. 11.4 months; p<0.001). Multivariate analysis confirmed high NLR as a strong independent risk factor for mortality (HR: 9.31, 95% CI: 3.18–27.28; p<0.001). Conversely, PIV, SII, PLR, and HALP scores showed no prognostic significance. While generally tolerable, the regimen caused vascular events in 14%. Conclusion: Among various inflammation indices, pre-treatment NLR emerged as a consistent and clinically relevant prognostic biomarker in rHGG patients treated with BEV+IRI. NLR-based stratification could optimize patient selection and reduce unnecessary toxicity. Keywords: Bevacizumab-Irinotecan, Neutrophil-to-Lymphocyte Ratio, Recurrent Gliomas
Cite This Article
Oyucu Orhan S, Orhan B, Hasanzade U, Sali S, Caner B, Ocak B, Şahin A, Deligönül A, Çubukçu E, Evrensel T. Optimizing Patient Selection for Bevacizumab Plus Irinotecan in Recurrent High Grade Glioma: Superiority of the Neutrophil-to-Lymphocyte Ratio Over Other Systemic Inflammation Indices. EJMI. 2026; 10(1): 37-45
Corresponding Author: Sibel Oyucu Orhan