| Abstrakt: |
BACKGROUND: Brain radionecrosis is an adverse event of radiation therapy for brain tumors or metastatic brain lesions. Radiation brain necrosis is characterized by an increased permeability and disruption of the blood--brain barrier. Currently, there is no standard treatment for brain radionecrosis. Radiation can cause endothelial damage, resulting in capillary leakage, hypoxia, and an increase of vascular endothelial growth factor (VEGF). Bevacizumab, an anti-VEGF antibody, has recently been used in studies for the treatment of brain radionecrosis. Bevacizumab blocks VEGF from reaching its targets on the endothelium, thus making it a promising treatment for brain radionecrosis. OBJECTIVE: To assess the effectiveness and safety of bevacizumab in the treatment of brain radionecrosis. METHODS: This study was a retrospective chart review of patients' age, sex, bevacizumab dose, dosing frequency, number of treatments received, medication-related adverse events, and clinical benefit between January 1, 2014, and November 30, 2019, at Memorial Cancer Institute. Patients aged ≥18 years who had brain radionecrosis and received treatment with bevacizumab were included in the analysis. Per the institution's standards, patients received 4 cycles of therapy to assess the efficacy of bevacizumab. Patients received an additional 4 cycles of treatment if they exhibited clinical benefit (ie, complete response, partial response, or stable disease). The primary end point was to determine if the patients who received bevacizumab for the treatment of brain radionecrosis had a clinical benefit. The secondary outcome was to assess the safety of bevacizumab for the treatment of brain radionecrosis in adults by evaluating the treatment-related adverse events. RESULTS: A total of 15 patients with brain radionecrosis who received bevacizumab were included in this study, of whom 14 patients had lung cancer and 1 had breast cancer. The median age was 65 years, and 10 (67%) of the 15 patients were women. Clinical benefit was achieved in 13 (87%) of the 15 patients. The most frequent dosing regimen administered was 10 mg/kg every 2 weeks, and the median number of treatment cycles was 8. Treatment with bevacizumab was well-tolerated, with 8 (53%) patients having grade ≤2 bevacizumab-related adverse events, including hypertension (27%), proteinuria (13%), thrombocytopenia (7%), and mild nosebleeds (7%). No grades 3 to 5 adverse events were noted. CONCLUSION: Our findings demonstrate clinical benefit with bevacizumab when used as treatment for brain radionecrosis. In addition, bevacizumab is well-tolerated and has an acceptable safety profile. [ABSTRACT FROM AUTHOR] |
