Matsuda Masahide, Ishikawa Eiichi, Yamamoto Tetsuya, Akutsu Hiroyoshi, Takano Shingo, Matsumura Akira
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Clin Neurosci. 2017 Jun;40:115-119. doi: 10.1016/j.jocn.2017.02.025. Epub 2017 Feb 27.
Although promising preliminary results have been widely observed with bevacizumab for recurrent malignant gliomas, many unanswered questions remain to be resolved to achieve an optimal outcome. No predictive biomarkers of a survival benefit from bevacizumab have been established, and no consensus exists about the response or survival benefit regarding the prior recurrence pattern or tumor location. Here we retrospectively analyzed the clinical benefit from bevacizumab for recurrent malignant gliomas in relation to the prior recurrence pattern or tumor location. Thirty-one consecutive patients with recurrent malignant gliomas who were treated with bevacizumab were investigated. The treatment response and survival benefit from bevacizumab were analyzed in association with age, sex, Karnofsky performance status, prior pathological diagnosis, prior recurrence pattern, primary location of tumor, recurrence status, and expression of angiogenic and hypoxic markers. The group with leptomeningeal dissemination had a significantly shorter median overall survival with bevacizumab (OS (6.0months, 95% confidence interval (CI) 1.4-10.7) compared to those in the local/distant group (11.8months, 95% CI 6.1-17.4). The median OS of the infratentorial tumor group and supratentorial tumor group were 9.2months (95% CI 5.0-13.4) and 10.4months (95% CI 6.6-14.3), respectively. With multivariate analysis, the prior recurrence pattern was the only independent prognostic factor of OS. Patients with leptomeningeal dissemination of recurrent malignant glioma experienced minimal benefit from bevacizumab. Therefore, in the context of cost effectiveness, bevacizumab is not recommended for patients with leptomeningeal dissemination.
尽管贝伐单抗治疗复发性恶性胶质瘤已广泛观察到有前景的初步结果，但要实现最佳疗效仍有许多未解决的问题有待解决。尚未建立贝伐单抗生存获益的预测生物标志物，对于既往复发模式或肿瘤位置的反应或生存获益也未达成共识。在此，我们回顾性分析了贝伐单抗治疗复发性恶性胶质瘤的临床获益与既往复发模式或肿瘤位置的关系。对连续31例接受贝伐单抗治疗的复发性恶性胶质瘤患者进行了研究。分析了贝伐单抗的治疗反应和生存获益与年龄、性别、卡氏功能状态、既往病理诊断、既往复发模式、肿瘤原发位置、复发状态以及血管生成和缺氧标志物表达的相关性。软脑膜播散组使用贝伐单抗后的中位总生存期明显短于局部/远处转移组（分别为6.0个月，95%置信区间[CI] 1.4 - 10.7）（局部/远处转移组为11.8个月，95% CI 6.1 - 17.4）。幕下肿瘤组和幕上肿瘤组的中位总生存期分别为9.2个月（95% CI 5.0 - 13.4）和10.4个月（95% CI 6.6 - 14.3）。多因素分析显示，既往复发模式是总生存期唯一的独立预后因素。复发性恶性胶质瘤软脑膜播散的患者从贝伐单抗中获益极小。因此，从成本效益角度考虑，不推荐对软脑膜播散患者使用贝伐单抗。
