Gronier S, Bourg V, Frenay M, Cohen M, Mondot L, Thomas P, Lebrun C
Service de neurologie, hôpital Pasteur, 30, voie Romaine, 06002 Nice cedex, France.
Rev Neurol (Paris). 2011 Apr;167(4):331-6. doi: 10.1016/j.neurol.2010.10.012. Epub 2011 Mar 21.
Bevacizumab is a monoclonal antibody, which neutralizes the effect of vascular endothelium growth factor (VEGF) allowing regression of tumour vessels and a decrease in the permeability of the blood-brain barrier. Already used in oncology as adjuvant treatment for certain metastatic cancers and in second line for high-grade gliomas, it has been recently used as a treatment of cerebral radionecrosis resisting conventional drug treatment and hyperbaric oxygen. This article presents three patients with cerebral radionecrosis and treated by monthly infusions of bevacizumab (10 mg/kg per month). The patients had developed cerebral radionecrosis after radiation therapy for a malignant brain tumour. The radionecrosis was proved by magnetic resonance imaging and spectroscopy. The first patient received only one perfusion of bevacizumab, as the development of a lymphopenia prevented the patient from continuing with the treatment. The second patient received four infusions, but the absence of improvement of the clinical symptoms and progression of the radiolesion led to discontinuation of the treatment. The third patient developed several severe side effects, a transient ischemic accident and a perforated corneal ulcer, resulting again in premature discontinuation of treatment. The development of severe side effects, combined with the absence of notable clinical and radiologic improvements resulting from the use of bevacizumab as a treatment resulted in the premature interruption of such treatment, in all three patients.
贝伐单抗是一种单克隆抗体，它可中和血管内皮生长因子（VEGF）的作用，使肿瘤血管消退，并降低血脑屏障的通透性。它已在肿瘤学中用作某些转移性癌症的辅助治疗药物以及高级别胶质瘤的二线治疗药物，最近还被用于治疗抵抗传统药物治疗和高压氧治疗的放射性脑坏死。本文介绍了3例接受每月输注贝伐单抗（每月10 mg/kg）治疗的放射性脑坏死患者。这些患者在恶性脑肿瘤放疗后发生了放射性脑坏死。通过磁共振成像和光谱学证实了放射性脑坏死。首例患者仅接受了一次贝伐单抗灌注，因为淋巴细胞减少症的出现使患者无法继续接受治疗。第二例患者接受了4次输注，但由于临床症状未改善且放射性损害进展，导致治疗中断。第三例患者出现了几种严重的副作用，即短暂性缺血性发作和角膜穿孔性溃疡，再次导致治疗提前终止。在所有3例患者中，严重副作用的出现，再加上使用贝伐单抗治疗后未出现明显的临床和影像学改善，导致这种治疗提前中断。
