Guiu S, Taillibert S, Chinot O, Taillandier L, Honnorat J, Dietrich P Y, Maire J-P, Guillamo J S, Guiu B, Catry-Thomas I, Capelle F, Thiebaut A, Cartalat-Carel S, Deville C, Fumoleau P, Desjardins A, Xuan K Hoang, Chauffert B
Département d'oncologie médicale, centre de lutte contre le cancer Georges-François-Leclerc, 1, rue Professeur Marion, 21000 Dijon, France.
Rev Neurol (Paris). 2008 Jun-Jul;164(6-7):588-94. doi: 10.1016/j.neurol.2008.04.003. Epub 2008 Jun 3.
Second-line chemotherapy is disappointing in recurrent high-grade gliomas. Dramatic responses in recurrent high-grade gliomas have been reported in a recent monocentric trial with a novel association combining bevacizumab (anti-VEGF monoclonal antibody agent) and irinitecan.
To report the experience of the ANOCEF group (French speaking neuro-oncology association) using the bevacizumab-irinotecan combination in recurrent high-grade gliomas.
Eight centers were involved in this retrospective multicenter study. Bevacizumab-irinotecan was delivered as previously described in a compassional setting to non-selected patients suffering from a high-grade glioma (WHO grade III and IV). Response rate at two months of the onset of the treatment was analyzed using the Macdonald criteria. The toxicity profile of the treatment was also investigated.
From 2006 to 2007, 77 patients were treated (median age: 52 years; median Karnofsky score: 70) for a recurrent high-grade glioma (49 grade IV, 28 grade III). At two months, the response rates were objective response=36% (54% in grade III and 27% in grade IV); stable disease=39%; progressive disease=13%; patients not evaluable because of a rapid fatal clinical deterioration=12%. Improvement was noted in 49% of patients. Among the main toxicities, we noted; intratumoral hemorrage (n=5 with spontaneous regression in three) and thromboembolic complications including venous thrombophlebitis (n=4), pulmonary embolism (n=2), myocardial infarction (n=1), grade III-IV hematotoxicity (n=2), reversible leukoencephalopathy (n=1).
This retrospective multicenter study adds further arguments in favor of the promising results of this new combination and its potential rapidity of action in recurrent high-grade gliomas. Antiangiogenic agents expose the patients to a well-known risk of thromboembolic and hemorragic complications, necessitating careful follow-up and patient selection in light of the cardiovascular contraindications.
二线化疗对复发性高级别胶质瘤效果不佳。最近一项单中心试验报告了一种新的联合用药方案（贝伐单抗[抗血管内皮生长因子单克隆抗体药物]与伊立替康联合）在复发性高级别胶质瘤中取得了显著疗效。
报告ANOCEF组（法语区神经肿瘤学协会）使用贝伐单抗-伊立替康联合方案治疗复发性高级别胶质瘤的经验。
八个中心参与了这项回顾性多中心研究。贝伐单抗-伊立替康按照之前在同情用药情况下的描述给予未经过挑选的高级别胶质瘤（世界卫生组织III级和IV级）患者。使用麦克唐纳标准分析治疗开始两个月时的缓解率。同时也对治疗的毒性特征进行了研究。
2006年至2007年，77例复发性高级别胶质瘤患者接受了治疗（中位年龄：52岁；中位卡诺夫斯基评分：70）（49例IV级，28例III级）。两个月时，缓解率为：客观缓解=36%（III级为54%，IV级为27%）；疾病稳定=39%；疾病进展=13%；因快速致命性临床恶化无法评估的患者=12%。49%的患者病情有改善。在主要毒性反应中，我们注意到：瘤内出血（n = 5，其中3例自发消退）和血栓栓塞并发症，包括静脉血栓性静脉炎（n = 4）、肺栓塞（n = 2）、心肌梗死（n = 1）、III-IV级血液毒性（n = 2）、可逆性白质脑病（n = 1）。
这项回顾性多中心研究进一步支持了这种新联合方案在复发性高级别胶质瘤中取得的有前景的结果及其潜在的快速起效作用。抗血管生成药物使患者面临已知的血栓栓塞和出血并发症风险，因此需要根据心血管方面的禁忌证进行仔细的随访和患者选择。
