Bevacizumab-based treatment as salvage therapy in patients with recurrent symptomatic brain metastases.

Autor:	Berghoff AS; Department of Medicine I, Medical University of Vienna, Vienna, Austria.; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany., Breckwoldt MO; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany., Riedemann L; Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.; Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany., Karimian-Jazi K; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany., Loew S; Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.; Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany., Schlieter F; Department of Medicine I, Medical University of Vienna, Vienna, Austria.; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Furtner J; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria., Cinci M; Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany., Thomas M; Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Center Heidelberg, Heidelberg, Germany., Strowitzki MJ; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany., Marmé F; National Center for Tumor Disease, Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany., Michel LL; National Center for Tumor Disease, Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany., Schmidt T; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany., Jäger D; Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany., Bendszus M; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany., Preusser M; Department of Medicine I, Medical University of Vienna, Vienna, Austria.; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Wick W; Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.; Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany., Winkler F; Clinical Cooperation Unit Neuro-Oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.; Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
Jazyk:	angličtina
Zdroj:	Neuro-oncology advances [Neurooncol Adv] 2020 Mar 16; Vol. 2 (1), pp. vdaa038. Date of Electronic Publication: 2020 Mar 16 (Print Publication: 2020).
DOI:	10.1093/noajnl/vdaa038
Abstrakt:	Background: Salvage treatment for recurrent brain metastases (BM) of solid cancers is challenging due to the high symptomatic burden and the limited local treatment options. Methods: Patients with recurrent BM with no option for further local therapies were retrospectively identified from BM databases. Bevacizumab-based treatment was initiated as a salvage treatment. Radiological imaging before and after bevacizumab-based treatment was reevaluated for treatment response using the Response Assessment in Neuro-Oncology (RANO) BM criteria. Results: Twenty-two patients (36.4% male) with recurrent BM from breast cancer (40.9%), colorectal cancer (31.8%), or lung cancer (27.3%) were identified. Previous BM-directed therapies were radiosurgery in 16/22 (72.7%) patients, whole-brain radiotherapy in 8/22 (36.4%), and neurosurgical resection in 11/22 (50.0%). Time since BM diagnosis to initiation of bevacizumab treatment was 16.5 months. Of 22 patients 14 (63.6%) received concurrent systemic therapies. Neurological symptom improvement could be achieved in 14/22 (63.6%) and stabilization in 6/22 (27.3%) patients, resulting in a clinical benefit in 20/22 (90.9%) patients. Steroids could be reduced or stopped in 15/22 (68.2%) patients. Rate of improvement on T1-weighted imaging was 15/19 (78.9%; median reduction: -26.0% ± 32.9) and 19/20 (95%; median reduction: -36.2% ± 22.2) on T2-weighted FLAIR imaging. According to RANO-BM best response was partial response in 7/19 (36.8%), stable disease in 9/19 (47.3%), and progressive disease in 3/19 (15.7%) patients. Median CNS-specific progression-free survival was 8 months and median overall survival after initiation of bevacizumab treatment was 17 months. Conclusions: Bevacizumab-based treatment had clinically relevant intracranial activity in the vast majority of patients suffering from recurrent, symptomatic BM. The data supports a prospective clinical trial of bevacizumab as a salvage treatment in BM. (© The Author(s) 2020. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)
Databáze:	MEDLINE
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