Narayana Ashwatha, Kelly Patrick, Golfinos John, Parker Erik, Johnson Glyn, Knopp Edmond, Zagzag David, Fischer Ingeborg, Raza Shahzad, Medabalmi Praveen, Eagan Patricia, Gruber Michael L
Department of Radiation Oncology, New York University Medical Center, New York, New York, USA.
J Neurosurg. 2009 Jan;110(1):173-80. doi: 10.3171/2008.4.17492.
Antiangiogenic agents have recently shown impressive radiological responses in high-grade glioma. However, it is not clear if the responses are related to vascular changes or due to antitumoral effects. The authors report the mature results of a clinical study of bevacizumab-based treatment of recurrent high-grade gliomas.
Sixty-one patients with recurrent high-grade gliomas received treatment with bevacizumab at 10 mg/ kg every 2 weeks for 4 doses in an 8-week cycle along with either irinotecan or carboplatin. The choice of concomitant chemotherapeutic agent was based on the number of recurrences and prior chemotherapy.
At a median follow-up of 7.5 months (range 1-19 months), 50 (82%) of 61 patients relapsed and 42 patients (70%) died of the disease. The median number of administered bevacizumab cycles was 2 (range 1-7 cycles). The median progression-free survival (PFS) and overall survival (OS) were 5 (95% confidence interval [CI] 2.3-7.7) and 9 (95% CI 7.6-10.4) months, respectively, as calculated from the initiation of the bevacizumab-based therapy. Radiologically demonstrated responses following therapy were noted in 73.6% of cases. Neither the choice of chemotherapeutic agent nor the performance of a resection prior to therapy had an impact on patient survival. Although the predominant pattern of relapse was local, 15 patients (30%) had diffuse disease.
Antiangiogenic therapy using bevacizumab appears to improve survival in patients with recurrent high-grade glioma. A possible change in the invasiveness of the tumor following therapy is worrisome and must be closely monitored.
抗血管生成药物最近在高级别胶质瘤中显示出令人印象深刻的放射学反应。然而，尚不清楚这些反应是与血管变化有关还是由于抗肿瘤作用。作者报告了一项基于贝伐单抗治疗复发性高级别胶质瘤的临床研究的成熟结果。
61例复发性高级别胶质瘤患者接受贝伐单抗治疗，剂量为10mg/kg，每2周一次，共4剂，8周为一个周期，同时联合伊立替康或卡铂。联合化疗药物的选择基于复发次数和既往化疗情况。
中位随访7.5个月（范围1 - 19个月），61例患者中有50例（82%）复发，42例患者（70%）死于该疾病。贝伐单抗给药周期的中位数为2（范围1 - 7个周期）。从基于贝伐单抗的治疗开始计算，中位无进展生存期（PFS）和总生存期（OS）分别为5个月（95%置信区间[CI] 2.3 - 7.7）和9个月（95% CI 7.6 - 10.4）。73.6%的病例在治疗后有放射学显示的反应。化疗药物的选择和治疗前是否进行手术切除均对患者生存无影响。尽管复发的主要模式是局部复发，但15例患者（30%）有弥漫性病变。
使用贝伐单抗的抗血管生成治疗似乎可改善复发性高级别胶质瘤患者的生存。治疗后肿瘤侵袭性可能发生的变化令人担忧，必须密切监测。
