Burger Michael C, Mildenberger Iris C, Wagner Marlies, Mittelbronn Michel, Steinbach Joachim P, Bähr Oliver
Dr. Senckenberg Institute of Neurooncology, Goethe University, 60528 Frankfurt, Germany.
Institute of Neuroradiology, Goethe University, 60528 Frankfurt, Germany.
Int J Mol Sci. 2017 Mar 29;18(4):726. doi: 10.3390/ijms18040726.
Bevacizumab has been shown to improve progression-free survival and neurologic function, but failed to improve overall survival in newly diagnosed glioblastoma and at first recurrence. Nonetheless, bevacizumab is widely used in patients with recurrent glioma. However, its use in patients with gliomas showing a gliomatosis cerebri growth pattern is contentious. Due to the marked diffuse and infiltrative growth with less angiogenic tumor growth, it may appear questionable whether bevacizumab can have a therapeutic effect in those patients. However, the development of nodular, necrotic, and/or contrast-enhancing lesions in patients with a gliomatosis cerebri growth pattern is not uncommon and may indicate focal neo-angiogenesis. Therefore, control of growth of these lesions as well as control of edema and reduction of steroid use may be regarded as rationales for the use of bevacizumab in these patients. In this retrospective patient series, we report on 17 patients with primary brain tumors displaying a gliomatosis cerebri growth pattern (including seven glioblastomas, two anaplastic astrocytomas, one anaplastic oligodendroglioma, and seven diffuse astrocytomas). Patients have been treated with bevacizumab alone or in combination with lomustine or irinotecan. Seventeen matched patients treated with bevacizumab for gliomas with a classical growth pattern served as a control cohort. Response rate, progression-free survival, and overall survival were similar in both groups. Based on these results, anti-angiogenic therapy with bevacizumab should also be considered in patients suffering from gliomas with a mainly infiltrative phenotype.
贝伐单抗已被证明可改善新诊断的胶质母细胞瘤和首次复发时的无进展生存期及神经功能，但未能改善总生存期。尽管如此，贝伐单抗仍广泛用于复发性胶质瘤患者。然而，其在呈现大脑胶质瘤病生长模式的胶质瘤患者中的应用存在争议。由于显著的弥漫性和浸润性生长以及血管生成较少的肿瘤生长，贝伐单抗在这些患者中是否能产生治疗效果可能存疑。然而，大脑胶质瘤病生长模式的患者出现结节性、坏死性和/或强化病变并不罕见，这可能表明存在局灶性新生血管形成。因此，控制这些病变的生长以及控制水肿和减少类固醇的使用可被视为在这些患者中使用贝伐单抗的理由。在这个回顾性患者系列中，我们报告了17例表现为大脑胶质瘤病生长模式的原发性脑肿瘤患者（包括7例胶质母细胞瘤、2例间变性星形细胞瘤、1例间变性少突胶质细胞瘤和7例弥漫性星形细胞瘤）。患者接受了单独使用贝伐单抗或与洛莫司汀或伊立替康联合使用的治疗。17例接受贝伐单抗治疗的具有经典生长模式的胶质瘤患者作为对照队列。两组的缓解率、无进展生存期和总生存期相似。基于这些结果，对于主要表现为浸润性表型的胶质瘤患者，也应考虑使用贝伐单抗进行抗血管生成治疗。
