Chamberlain Marc C, Johnston Sandra
Department of Neurology and Neurosurgery, University of Washington/Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Cancer. 2009 Apr 15;115(8):1734-43. doi: 10.1002/cncr.24179.
A retrospective evaluation of single agent bevacizumab was carried out in adults with recurrent alkylator-refractory 1p19q codeleted anaplastic oligodendrogliomas (AO) with an objective of determining progression-free survival (PFS). There is no standard therapy for alkylator-resistant AO, and hence a need exists for new therapies.
Twenty-two patients aged 24 to 60 years with recurrent AO were treated. All patients had previously been treated with surgery, radiotherapy, adjuvant chemotherapy (temozolomide, 17; carmustine wafers, 4; carmustine, 1), and 1 salvage regimen (procarbazine, lomustine, and vincristine, 15; temozolomide, 6; carmustine wafers, 1). Eleven patients underwent repeat surgery. Patients were treated at second recurrence with bevacizumab, once every 2 weeks, defined as a single cycle. Neurological evaluation was performed every 2 weeks, and neuroradiographic assessment was made after the initial 2 cycles of bevacizumab and subsequently after every 4 cycles of bevacizumab.
A total of 391 cycles of bevacizumab (median, 14.5 cycles; range, 2-39 cycles) were administered. Bevacizumab-related toxicity included fatigue (14 patients; 4 grade 3), leukopenia (9; 1 grade 3), anemia (5; 0 grade 3), hypertension (5; 1 grade 3), deep vein thrombosis (4; 1 grade 3), and wound dehiscence (2; 1 grade 3). Fifteen (68%) patients demonstrated a partial radiographic response, 1 (5.0%) demonstrated stable disease, and 6 (27%) demonstrated progressive disease after 2 cycles of bevacizumab. Time to tumor progression ranged from 1 to 18 months (median, 6.75 months). Survival ranged from 3 to 19 months (median, 8.5 months). Six-month and 12-month PFS were 68% and 23%, respectively.
Bevacizumab demonstrated efficacy and acceptable toxicity in this cohort of adults with recurrent 1p19q codeleted alkylator-refractory AO.
对复发的烷化剂难治性、1p19q 共缺失间变性少突胶质细胞瘤（AO）成人患者进行了单药贝伐单抗的回顾性评估，目的是确定无进展生存期（PFS）。对于烷化剂耐药的 AO 尚无标准治疗方法，因此需要新的治疗方法。
对 22 例年龄在 24 至 60 岁的复发 AO 患者进行了治疗。所有患者此前均接受过手术、放疗、辅助化疗（替莫唑胺，17 例；卡莫司汀晶片，4 例；卡莫司汀，1 例）以及 1 种挽救方案（丙卡巴肼、洛莫司汀和长春新碱，15 例；替莫唑胺，6 例；卡莫司汀晶片，1 例）。11 例患者接受了再次手术。患者在第二次复发时接受贝伐单抗治疗，每 2 周 1 次，定义为 1 个周期。每 2 周进行一次神经学评估，在贝伐单抗最初 2 个周期后以及随后每 4 个周期后进行神经影像学评估。
共给予 391 个周期的贝伐单抗（中位数为 14.5 个周期；范围为 2 - 39 个周期）。与贝伐单抗相关的毒性包括疲劳（14 例患者；4 例 3 级）、白细胞减少（9 例；1 例 3 级）、贫血（5 例；0 例 3 级）、高血压（5 例；1 例 3 级）、深静脉血栓形成（4 例；1 例 3 级）和伤口裂开（2 例；1 例 3 级）。15 例（68%）患者显示部分影像学缓解，1 例（5.0%）显示疾病稳定，6 例（27%）在 2 个周期的贝伐单抗治疗后显示疾病进展。肿瘤进展时间为 1 至 18 个月（中位数为 6.75 个月）。生存期为 3 至 19 个月（中位数为 8.5 个月）。6 个月和 12 个月的 PFS 分别为 68%和 23%。
在这组复发的 1p19q 共缺失烷化剂难治性 AO 成人患者中，贝伐单抗显示出疗效且毒性可接受。
