Hematology/Oncology Division, Oregon Health Sciences University, Portland, OR 97239, USA.
Lung Cancer. 2012 Oct;78(1):1-7. doi: 10.1016/j.lungcan.2012.07.004. Epub 2012 Aug 9.
Vascular endothelial growth factor (VEGF) is a key mediator of angiogenesis. Solid tumors, including non-small cell lung cancer (NSCLC), are dependent on angiogenesis for growth and metastasis. Anti-VEGF therapy has demonstrated clinical benefits in the first-line treatment of NSCLC. Central nervous system (CNS) metastases are a common occurrence among patients with lung cancer and confer significant morbidity and mortality. The risk of CNS hemorrhage in NSCLC patients receiving anti-VEGF therapy is still relatively unexplored because patients with CNS metastases have generally been excluded from trials of anti-VEGF therapy due to a perceived increased risk of cerebral hemorrhage. Recently, large prospective, randomized trials, open-label studies and observational cohort studies in NSCLC have provided data on the incidence of CNS hemorrhage in large patient populations, reflective of community practice.
We conducted a literature review for the available data on the incidence of CNS hemorrhage in NSCLC patients with brain metastases receiving anti-VEGF therapy.
There is no significantly increased risk of CNS hemorrhage in patients with NSCLC and emerging (previously untreated) or pretreated CNS metastases receiving anti-VEGF therapy.
We conclude that clinical trial data indicate that anti-VEGF therapy can be considered for NSCLC patients with emerging or pretreated CNS metastases.
血管内皮生长因子（VEGF）是血管生成的关键介质。包括非小细胞肺癌（NSCLC）在内的实体瘤的生长和转移依赖于血管生成。抗 VEGF 治疗在 NSCLC 的一线治疗中已显示出临床获益。中枢神经系统（CNS）转移是肺癌患者常见的并发症，会导致严重的发病率和死亡率。接受抗 VEGF 治疗的 NSCLC 患者发生 CNS 出血的风险仍相对未知，因为由于脑出血风险增加的认知，CNS 转移患者通常被排除在抗 VEGF 治疗的试验之外。最近，在 NSCLC 中进行的大型前瞻性、随机试验、开放标签研究和观察性队列研究提供了大量患者人群中 CNS 出血发生率的数据，反映了临床实践情况。
我们对现有关于接受抗 VEGF 治疗的有脑转移的 NSCLC 患者 CNS 出血发生率的文献数据进行了综述。
在接受抗 VEGF 治疗的有新发（以前未经治疗）或经治 CNS 转移的 NSCLC 患者中，CNS 出血的风险没有显著增加。
我们的结论是，临床试验数据表明，对于有新发或经治 CNS 转移的 NSCLC 患者，可以考虑使用抗 VEGF 治疗。
