Department of Neuro-oncology, University Clinic Heidelberg, Germany.
Ann Neurol. 2011 Mar;69(3):586-92. doi: 10.1002/ana.22336.
Preclinical evidence and uncontrolled clinical studies suggest an increased risk for distant spread and development of a gliomatosislike phenotype at recurrence or progression of malignant glioma patients treated with bevacizumab (BEV), an antibody to vascular endothelial growth factor (VEGF). Here we asked whether BEV treatment of recurrent malignant glioma increases the risk of distant or diffuse tumor spread at further recurrence. BEV-treated patients were compared with matched pairs of patients treated without anti-VEGF regimens. T1 contrast-enhanced (T1+c) and fluid-attenuated inversion recovery (FLAIR) images were analyzed using a novel automated tool of image analysis. At the start of the study, 20.5% of BEV-treated and 22.7% of non-BEV-treated patients had displayed distant or diffuse recurrence. Distant or diffuse recurrences were observed in 22% (BEV) and 18% (non-BEV) on T1+c and in 25% and 18% on FLAIR (p > 0.05). The correlation between changes on T1+c and FLAIR at progression was high. The risk of distant or diffuse recurrence at the time of failure of BEV-containing treatments was not higher than with anti-VEGF-free regimens, arguing against a specific property of BEV that promotes distant tumor growth or a gliomatosislike phenotype at recurrence.
临床前证据和未经对照的临床研究表明，在接受贝伐单抗（bevacizumab，一种血管内皮生长因子 [VEGF] 抗体）治疗的恶性胶质瘤患者复发或进展时，远处播散和发生胶质瘤样表型的风险增加。在这里，我们想知道贝伐单抗治疗复发性恶性胶质瘤是否会增加进一步复发时远处或弥漫性肿瘤播散的风险。我们将接受贝伐单抗治疗的患者与未接受抗 VEGF 治疗方案的匹配患者进行了比较。使用图像分析的新自动工具分析 T1 对比增强（T1+c）和液体衰减反转恢复（FLAIR）图像。在研究开始时，20.5%的贝伐单抗治疗患者和 22.7%的未接受贝伐单抗治疗的患者显示有远处或弥漫性复发。在 T1+c 上观察到 22%（贝伐单抗）和 18%（非贝伐单抗）的远处或弥漫性复发，在 FLAIR 上观察到 25%和 18%的远处或弥漫性复发（p＞0.05）。进展时 T1+c 和 FLAIR 之间的变化相关性很高。在贝伐单抗联合治疗失败时出现远处或弥漫性复发的风险并不高于无抗 VEGF 治疗方案，这表明贝伐单抗没有促进远处肿瘤生长或在复发时发生胶质瘤样表型的特定特性。
