Service d'Oncologie Pédiatrique, CHU Nantes, Nantes, France.
Pediatr Blood Cancer. 2012 Jul 15;59(1):34-8. doi: 10.1002/pbc.24066. Epub 2012 Jan 27.
Bevacizumab, a monoclonal antibody targeting the vascular endothelial growth factor, has proven efficacy in some adult tumors; it is now proposed as a new therapeutic strategy for refractory or recurrent brain tumors in some children, either alone or combinated.
We retrospectively analyzed 28 children who received bevacizumab on a compassionate basis for refractory or recurrent brain tumors between June 2007 and August 2010 in 7 French centers. Among them, 12 had high-grade gliomas, 7 low-grade gliomas, 4 ependymomas, 2 primitive neurectodermal tumors, 3 neuroglial tumors. The median age at start of bevacizumab was 11.0 years. Bevacizumab was administered at 5-10 mg/kg every 2 weeks, with concomitant chemotherapy for 27 patients.
Bevacizumab was used in combination with irinotecan in 27 patients. Bevacizumab-related toxicity was mild. Toxicities reported were grade I-II hypertension (n = 4), proteinuria (n = 1), lymphopenia (n = 2), wound healing delay (n = 2). Whereas tumor reduction could be observed in 6:7 patients with low-grade gliomas, no efficacy could be documented in patients with high-grade glioma, nor PNET nor ependymoma.
Bevacizumab-related acute toxicity appears to be low in children, even in combination with irinotecan. Further prospective trials are required to confirm the hypothetical efficacy of bevacizumab and to assess the risk of long-term toxicity especially in the youngest children.
贝伐单抗是一种针对血管内皮生长因子的单克隆抗体，已被证明在一些成人肿瘤中具有疗效；现在，它被提议作为一种新的治疗策略，用于一些儿童的难治性或复发性脑肿瘤，无论是单独使用还是联合使用。
我们回顾性分析了 2007 年 6 月至 2010 年 8 月期间，7 个法国中心的 28 名接受贝伐单抗治疗的难治性或复发性脑肿瘤患儿。其中，12 例为高级别胶质瘤，7 例为低级别胶质瘤，4 例为室管膜瘤，2 例为原始神经外胚层肿瘤，3 例为神经胶质肿瘤。贝伐单抗开始治疗的中位年龄为 11.0 岁。贝伐单抗的剂量为 5-10mg/kg，每 2 周 1 次，同时 27 例患者接受联合化疗。
27 例患者接受了贝伐单抗联合伊立替康的治疗。贝伐单抗相关毒性较轻。报告的毒性为 1 级-2 级高血压（n = 4）、蛋白尿（n = 1）、淋巴细胞减少（n = 2）、伤口愈合延迟（n = 2）。虽然低级别胶质瘤患者中有 67%的患者肿瘤缩小，但高级别胶质瘤、原始神经外胚层肿瘤和室管膜瘤患者均未见疗效。
贝伐单抗相关的急性毒性在儿童中似乎较低，即使与伊立替康联合使用也是如此。需要进一步的前瞻性试验来证实贝伐单抗的假设疗效，并评估特别是在最小儿童中潜在的长期毒性风险。
