1
|
Gupta T, Sahoo RK, Singh H, Katke S, Chaurasiya A, Gupta U. Lipid-Based Nanocarriers in the Treatment of Glioblastoma Multiforme (GBM): Challenges and Opportunities. AAPS PharmSciTech 2023; 24:102. [PMID: 37041350 DOI: 10.1208/s12249-023-02555-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/13/2023] [Indexed: 04/13/2023] Open
Abstract
Glioblastoma multiforme (also known as glioblastoma; GBM) is one of the most malignant types of brain tumors that occurs in the CNS. Treatment strategies for glioblastoma are majorly comprised of surgical resection, radiotherapy, and chemotherapy along with combination therapy. Treatment of GBM is itself a tedious task but the involved barriers in GBM are one of the main impediments to move one step closer to the treatment of GBM. Basically, two of the barriers are of utmost importance in this regard, namely blood brain barrier (BBB) and blood brain tumor barrier (BBTB). This review will address different challenges and barriers in the treatment of GBM along with their etiology. The role and recent progress of lipid-based nanocarriers like liposomes, solid lipid nanocarriers (SLNs), nanostructured lipid carriers (NLCs), lipoplexes, and lipid hybrid carriers in the effective management of GBM will be discussed in detail.
Collapse
Affiliation(s)
- Tanisha Gupta
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan, 305817, India
| | - Rakesh K Sahoo
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan, 305817, India
| | - Himani Singh
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan, 305817, India
| | - Sumeet Katke
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal District, Telangana, 500078, India
| | - Akash Chaurasiya
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal District, Telangana, 500078, India
| | - Umesh Gupta
- Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan, 305817, India.
| |
Collapse
|
2
|
Wang X, Chen D, Qiu J, Li S, Zheng X. The relationship between the degree of brain edema regression and changes in cognitive function in patients with recurrent glioma treated with bevacizumab and temozolomide. Quant Imaging Med Surg 2021; 11:4556-4568. [PMID: 34737923 DOI: 10.21037/qims-20-1084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 06/22/2021] [Indexed: 11/06/2022]
Abstract
Background This retrospective study aims to assess the impacts on cognitive status and quality of life in recurrent high-grade glioma patients treated with temozolomide (TMZ), either alone or in combination with bevacizumab (BEV), and explore the relationship between the brain edema regression, BEV use, and cognitive status. Methods A total of 125 patients with recurrent high-grade glioma were enrolled in this study, of which 65 patients were treated with BEV (5-10 mg/kg IV every 2 weeks) plus TMZ (200 mg/m2 every 28 days, d1-5), and 60 patients were treated with TMZ (200 mg/m2 every 28 days, d1-5) alone. The treatment response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria. Tumor-associated edema was evaluated with T2WI magnetic resonance imaging (MRI) and quantitative T2 mapping sequence, and an Edema Regression Index was designed to quantify volumetric changes in edema imaging after every treatment cycle. Cognitive intelligence state and quality of life were evaluated using the Mini-Mental State Examination (MMSE) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30). Results Radiologically, the partial response rate was 78.5% in the BEV + TMZ group and 38.3% in the TMZ group. After the first cycle of treatment, the mean score of the MMSE was 21.1±2.0 and 24.1±1.4 (P<0.001) in the TMZ group and the BEV + TMZ group, respectively. In the functioning domains of the QLQ-C30, scales of physical functioning, emotional functioning and cognitive functioning were 43.0±7.0 vs. 61.7±12.5 (P<0.001), 44.5±8.8 vs. 63.4±6.9 (P<0.001) and 42.4±8.8 vs. 63.7±12.0 (P<0.001) in the TMZ group and the BEV + TMZ group, respectively. In the BEV + TMZ group, a correlation between the Edema Regression Index and improvement in cognitive status and quality of life was observed. Patients with Edema Regression Index scores higher than 50% gained a 25.6% increase in the mean MMSE score from 19.9±1.6 to 25.0±1.1 (P<0.001). In the BEV + TMZ group, physical functioning, emotional functioning, and cognitive functioning increased by 76.8%, 53.1%, and 81.5%, respectively, while scores of nausea/vomiting decreased by 40.3% to 32.1. Patients with no evident edema observed in the pre-BEV MRI scans were given a prolonged four-cycle course of BEV. No significant improvement was observed in the MMSE score and the QLQ score with additional cycles of BEV. Conclusions A close relationship was observed between Edema Regression Index and a change in cognitive function in patients treated with BEV and TMZ. Compared with TMZ alone, the combination of TMZ and BEV could improve the cognitive function and quality of life of patients with recurrent high-grade gliomas. The Edema Regression Index could be used as a surrogate imaging biomarker to predict patients who may or may not gain cognitive benefit from the combination therapy of TMZ and BEV, which warrants further prospective clinical studies for validation.
Collapse
Affiliation(s)
- Xianglian Wang
- Department of Radiation Oncology, Fudan University Huadong Hospital, Shanghai, China
| | - Di Chen
- Department of Radiation Oncology, Fudan University Huadong Hospital, Shanghai, China
| | - Jianjian Qiu
- Department of Radiation Oncology, Fudan University Huadong Hospital, Shanghai, China
| | - Shihong Li
- Imaging Center, Fudan University Huadong Hospital, Shanghai, China
| | - Xiangpeng Zheng
- Department of Radiation Oncology, Fudan University Huadong Hospital, Shanghai, China
| |
Collapse
|
3
|
Funakoshi Y, Hata N, Kuga D, Hatae R, Sangatsuda Y, Fujioka Y, Takigawa K, Mizoguchi M. Update on Chemotherapeutic Approaches and Management of Bevacizumab Usage for Glioblastoma. Pharmaceuticals (Basel) 2020; 13:E470. [PMID: 33339404 PMCID: PMC7766528 DOI: 10.3390/ph13120470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
Glioblastoma, the most common primary brain tumor in adults, has one of the most dismal prognoses in cancer. In 2009, bevacizumab was approved for recurrent glioblastoma in the USA. To evaluate the clinical impact of bevacizumab as a first-line drug for glioblastoma, two randomized clinical trials, AVAglio and RTOG 0825, were performed. Bevacizumab was found to improve progression-free survival (PFS) and was reported to be beneficial for maintaining patient performance status as an initial treatment. These outcomes led to bevacizumab approval in Japan in 2013 as an insurance-covered first-line drug for glioblastoma concurrently with its second-line application. However, prolongation of overall survival was not evinced in these clinical trials; hence, the clinical benefit of bevacizumab for newly diagnosed glioblastomas remains controversial. A recent meta-analysis of randomized controlled trials of bevacizumab combined with temozolomide in recurrent glioblastoma also showed an effect only on PFS, and the benefit of bevacizumab even for recurrent glioblastoma is controversial. Here, we discuss the clinical impact of bevacizumab for glioblastoma treatment by reviewing previous clinical trials and real-world evidence by focusing on Japanese experiences. Moreover, the efficacy and safety of bevacizumab are summarized, and we provide suggestions for updating the approaches and management of bevacizumab.
Collapse
Affiliation(s)
| | - Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan; (Y.F.); (D.K.); (R.H.); (Y.S.); (Y.F.); (K.T.); (M.M.)
| | | | | | | | | | | | | |
Collapse
|
4
|
Gleeson JP, Keane F, Keegan NM, Mammadov E, Harrold E, Alhusaini A, Harte J, Eakin-Love A, O'Halloran PJ, MacNally S, Hennessy BT, Breathnach OS, Grogan L, Morris PG. Similar overall survival with reduced vs. standard dose bevacizumab monotherapy in progressive glioblastoma. Cancer Med 2019; 9:469-475. [PMID: 31756059 PMCID: PMC6970030 DOI: 10.1002/cam4.2616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Bevacizumab has demonstrated activity in glioblastoma (GBM), but the true benefits and optimal dose-schedule are debated. A lower dose-schedule than standard-dose bevacizumab (10 mg/kg 2-weekly) might offer similar benefits with lower costs. At our Institution, patients are randomly assigned at time of primary diagnosis to Neuro-Oncologists, who have varying practices in terms of bevacizumab dose-schedule upon progression. METHODS In a retrospective analysis we examined overall survival (OS), measured from first administered bevacizumab dose until death, according to dose-schedule. Patients with de novo WHO Grade IV GBM who received standard- or reduced-dose (5 mg/kg 2-weekly) bevacizumab were included. MGMT methylation status and time from diagnosis to bevacizumab start were examined as prognostic variables. Clinical benefit and a comparative cost analysis were assessed. RESULTS In total, 1127 bevacizumab doses were administered to 118 patients [Median: 7, Range: 1-44]. Median OS (mOS) was 5.8 months. 69 (59%) patients received standard-dose bevacizumab (mOS: 5.97 months) and 49 patients received reduced-dose (mOS: 5.7 months). No statistically significant difference in OS between dosing schedule was seen (HR: 1.11, P-value: .584). Patients with MGMT methylated tumors (43%) had improved OS compared to those with unmethylated tumors; 7.03 vs 4.97 months (HR: 0.61, P-value: .027). If all patients were treated with reduced-dose bevacizumab, an estimated €2.4M cost reduction would be observed. CONCLUSIONS In this retrospective study, reduced-dose bevacizumab schedule resulted in similar OS to standard-dose bevacizumab monotherapy with substantial cost savings. MGMT methylation appears to convey a survival benefit in the setting of bevacizumab treatment for progressive GBM.
Collapse
Affiliation(s)
- Jack Patrick Gleeson
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fergus Keane
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | - Niamh M Keegan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emin Mammadov
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | - Emily Harrold
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Abdullah Alhusaini
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
| | - Jeffrey Harte
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
| | | | | | | | - Bryan T Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Rebrikova VA, Sergeev NI, Padalko VV, Kotlyarov PM, Solodkiy VA. [The use of MR perfusion in assessing the efficacy of treatment for malignant brain tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:113-120. [PMID: 31577277 DOI: 10.17116/neiro201983041113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This literature review analyzes the capabilities of magnetic resonance imaging (MRI)-based cerebral perfusion for differentiation between post-radiation changes (e.g., radionecrosis) and continued growth. The technique is compared with other highly informative radiodiagnostic techniques used in neuroradiology. The use of MR perfusion is important in a comprehensive examination protocol. Trends in the technique development are analyzed.
Collapse
Affiliation(s)
- V A Rebrikova
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - N I Sergeev
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - V V Padalko
- Sechenov First Moscow Medical University, Moscow, Russia
| | - P M Kotlyarov
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - V A Solodkiy
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| |
Collapse
|
6
|
Tsuchiya K, Karayama M, Yasui H, Hozumi H, Suzuki Y, Furuhashi K, Enomoto N, Fujisawa T, Nakamura Y, Inui N, Suda T. An Acquired Epidermal Growth Factor Receptor T790M Mutation after the Addition of Bevacizumab to Preceding Erlotinib Monotherapy in a Lung Cancer Patient with Leptomeningeal Metastases. Intern Med 2018; 57:3423-3427. [PMID: 30101917 PMCID: PMC6306543 DOI: 10.2169/internalmedicine.1062-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 53-year-old man with advanced lung adenocarcinoma harboring epidermal growth factor receptor (EGFR) exon 19 deletion received erlotinib. After 12 months of disease control with erlotinib monotherapy, leptomeningeal metastases (LM) occurred. A cerebrospinal fluid examination demonstrated a pre-existing EGFR exon 19 deletion. Bevacizumab was combined with erlotinib, and the LM improved. After six months of combination therapy, however, the LM was exacerbated. A re-examination of the cerebrospinal fluid revealed a T790M mutation and exon 19 deletion. Osimertinib was administered, and the LM improved. The combination of bevacizumab and erlotinib was effective for erlotinib-resistant LM and resulted in the expression of a newly acquired T790M mutation, which enabled successful treatment with osimertinib.
Collapse
Affiliation(s)
- Kazuo Tsuchiya
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Masato Karayama
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
- Department of Clinical Oncology, Hamamatsu University School of Medicine, Japan
| | - Hideki Yasui
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Hironao Hozumi
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yuzo Suzuki
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Kazuki Furuhashi
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Noriyuki Enomoto
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Tomoyuki Fujisawa
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yutaro Nakamura
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Naoki Inui
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Takafumi Suda
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| |
Collapse
|
7
|
Abstract
Background: Adult pilocytic astrocytomas are rare and highly vascular tumors. Aim: We hypothesized that they may be uniquely responsive to bevacizumab (BEV). Patients: We present four adult patients with pathologically diagnosed WHO grade I pilocytic astrocytoma who had robust and durable responses to BEV at time of recurrence. Three patients developed radiographic changes on MRI, consistent with progressive disease based on response assessment in neuro-oncology criteria. Median time to recurrence was 8.5 months. Methods: All patients were treated with six cycles of BEV for recurrence. Results: At the end of treatment, all patients had achieved a clinical and radiographic response. Median follow-up time after BEV is 20.5 months. Conclusion: This suggests that BEV may have true antitumor activity in adult pilocytic astrocytomas and may be important for achieving durable disease control.
Collapse
Affiliation(s)
- Andrea Wasilewski
- Department of Neurology, University of Rochester, Box 704, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Nimish Mohile
- Department of Neurology, University of Rochester, Box 704, 601 Elmwood Avenue, Rochester, NY 14642, USA
| |
Collapse
|
8
|
Bevacizumab for Patients with Recurrent Multifocal Glioblastomas. Int J Mol Sci 2017; 18:ijms18112469. [PMID: 29156610 PMCID: PMC5713435 DOI: 10.3390/ijms18112469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022] Open
Abstract
In patients with glioblastoma, antiangiogenic therapy with bevacizumab (BEV) has been shown to improve progression-free survival (PFS), but not overall survival (OS). Especially in patients with an unusual infiltrative phenotype as seen in multifocal glioblastoma, the use of BEV therapy is still more controversial. Therefore, we prepared a retrospective case series with 16 patients suffering from a multifocal glioblastoma treated with BEV. We compared these patients to a matched control cohort of 16 patients suffering from glioblastoma with a single lesion treated with BEV. The objective of this study was to evaluate whether the course of disease differs in glioblastoma patients with a multifocal disease pattern compared to those with a single lesion only. Patients were treated with BEV monotherapy or BEV in combination with irinotecan or lomustine (CCNU). Response rates and PFS were similar in both groups. There was a trend for an unfavorable OS in the patient group with multifocal glioblastoma, which was expected due to the generally worse prognosis of multifocal glioblastoma. We investigated whether BEV therapy affects the invasive growth pattern as measured by the appearance of new lesions on magnetic resonance imaging (MRI). Under BEV therapy, there was a trend for a lower frequency of new lesions both in multifocal and solitary glioblastoma. Based on these results, BEV therapy at relapse appears to be justified to no lesser extent in multifocal glioblastoma than in solitary glioblastoma.
Collapse
|
9
|
Xue W, Du X, Wu H, Liu H, Xie T, Tong H, Chen X, Guo Y, Zhang W. Aberrant glioblastoma neovascularization patterns and their correlation with DCE-MRI-derived parameters following temozolomide and bevacizumab treatment. Sci Rep 2017; 7:13894. [PMID: 29066764 PMCID: PMC5654943 DOI: 10.1038/s41598-017-14341-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/10/2017] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma (GBM) is a highly angiogenic malignancy, and its abundant, aberrant neovascularization is closely related to the proliferation and invasion of tumor cells. However, anti-angiogenesis combined with standard radio-/chemo-therapy produces little improvement in treatment outcomes. Determining the reason for treatment failure is pivotal for GBM treatment. Here, histopathological analysis and dynamic contrast-enhanced MRI (DCE-MRI) were used to explore the effects of temozolomide (TMZ) and bevacizumab (BEV) on GBM neovascularization patterns in an orthotopic U87MG mouse model at 1, 3 and 6 days after treatment. We found that the amount of vascular mimicry (VM) significantly increased 6 days after BEV treatment. TMZ inhibited neovascularization at an early stage, but the microvessel density (MVD) and transfer coefficient (Ktrans) derived from DCE-MRI increased 6 days after treatment. TMZ and BEV combination therapy slightly prolonged the inhibitory effect on tumor microvessels. Sprouting angiogenesis was positively correlated with Ktrans in all treatment groups. The increase in VM after BEV administration and the increase in MVD and Ktrans after TMZ administration may be responsible for treatment resistance. Ktrans holds great potential as an imaging biomarker for indicating the variation in sprouting angiogenesis during drug treatment for GBM.
Collapse
Affiliation(s)
- Wei Xue
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Xuesong Du
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Hao Wu
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Heng Liu
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Tian Xie
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Haipeng Tong
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Xiao Chen
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Yu Guo
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Weiguo Zhang
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
- Chongqing Clinical Research Center for Imaging and Nuclear Medicine, Chongqing, 400042, China.
| |
Collapse
|
10
|
Bevacizumab for Patients with Recurrent Gliomas Presenting with a Gliomatosis Cerebri Growth Pattern. Int J Mol Sci 2017; 18:ijms18040726. [PMID: 28353668 PMCID: PMC5412312 DOI: 10.3390/ijms18040726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 02/01/2023] Open
Abstract
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.
Collapse
|
11
|
Abstract
OBJECTIVE Chronic pain is a well-known morbidity associated with neurofibromatosis (NF) for which better therapies are needed. Surgery, radiation, and pain medications have been utilized, but often fail to relieve debilitating pain. One patient at our institution was noted to have near complete resolution of pain after treatment with bevacizumab for progressive neurologic deficit associated with NF2, suggesting its potential as an effective pain control method. We aim to better characterize the use of bevacizumab for pain control in this subset of patients. Patients and Methods: We retrospectively reviewed 38 NF patients treated at our institution. Results: Of the 38 total NF patients, we found that 63% reported chronic pain, with 18% reporting chronic opiate usage. Nine patients with chronic pain were considered for bevacizumab treatment and five went on to receive infusions. Of these patients, four out of five had previous surgical debulking and two out of five had previous radiation for attempted pain control. One patient had a lesion not amenable to surgery or radiation. Patients received a median of 13 cycles of bevacizumab, and four out of five patients reported a decrease in subjective pain. All patients that had pain relief had a relapse of pain symptoms when the dose was reduced or infusions were paused. Seventy-five percent were able to decrease opiate use. No major complications were noted. All five patients have elected to continue infusions for pain control. Conclusion: Bevacizumab was, in general, well tolerated and should be considered as a treatment option in NF patients with chronic pain refractory or not amenable to surgical decompression and debulking, radiation, and pain medication.
Collapse
Affiliation(s)
- Xu W Linda
- Department of Neurosurgery, Stanford University School of Medicine
| | | |
Collapse
|
12
|
Eilaghi A, Yeung T, d'Esterre C, Bauman G, Yartsev S, Easaw J, Fainardi E, Lee TY, Frayne R. Quantitative Perfusion and Permeability Biomarkers in Brain Cancer from Tomographic CT and MR Images. BIOMARKERS IN CANCER 2016; 8:47-59. [PMID: 27398030 PMCID: PMC4933536 DOI: 10.4137/bic.s31801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/28/2022]
Abstract
Dynamic contrast-enhanced perfusion and permeability imaging, using computed tomography and magnetic resonance systems, are important techniques for assessing the vascular supply and hemodynamics of healthy brain parenchyma and tumors. These techniques can measure blood flow, blood volume, and blood-brain barrier permeability surface area product and, thus, may provide information complementary to clinical and pathological assessments. These have been used as biomarkers to enhance the treatment planning process, to optimize treatment decision-making, and to enable monitoring of the treatment noninvasively. In this review, the principles of magnetic resonance and computed tomography dynamic contrast-enhanced perfusion and permeability imaging are described (with an emphasis on their commonalities), and the potential values of these techniques for differentiating high-grade gliomas from other brain lesions, distinguishing true progression from posttreatment effects, and predicting survival after radiotherapy, chemotherapy, and antiangiogenic treatments are presented.
Collapse
Affiliation(s)
- Armin Eilaghi
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Timothy Yeung
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Christopher d'Esterre
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Glenn Bauman
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Slav Yartsev
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Jay Easaw
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy.; Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Ting-Yim Lee
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Richard Frayne
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| |
Collapse
|
13
|
Perfusion MRI as the predictive/prognostic and pharmacodynamic biomarkers in recurrent malignant glioma treated with bevacizumab: a systematic review and a time-to-event meta-analysis. J Neurooncol 2016; 128:185-94. [PMID: 27108275 DOI: 10.1007/s11060-016-2102-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/04/2016] [Indexed: 12/15/2022]
Abstract
This study aims to evaluate the value of perfusion MRI as a predictive/prognostic biomarker and a pharmacodynamic biomarker in patients with recurrent glioma treated with a bevacizumab-based regimen. We identified thirteen literature reports that investigated dynamic susceptibility-contrast (DSC) MRI or dynamic contrast-enhanced (DCE) MRI for predicting the patient outcome and analyzing the anti-angiogenic effect of bevacizumab by performing a systematic search of MEDLINE and EMBASE. The relative cerebral volume (rCBV) of DSC-MRI is currently the most common perfusion MRI parameter used as a predictive/prognostic biomarker. Pooled hazard ratios between responders and non-responders, as determined by rCBV, were 0.46 (95 % CI 0.28-0.76) for progression-free survival from five articles with a total 226 patients and 0.47 (95 % CI 0.29-0.76) for overall survival from six articles with a total 247 patients, and thus indicating that rCBV is helpful for predicting disease progression and the eventual outcome after treatment. Regarding the pharmacodynamic value of perfusion MRI parameters derived from either DSC-MRI or DCE-MRI, most perfusion MRI parameters (rCBV, Ktrans, CBVmax, Kpsmax, fpv, Ve and Kep) demonstrated a consistent decrease on the follow-up MRI after treatment, indicating that perfusion MRI may be helpful for evaluating the anti-angiogenic effect of a bevacizumab-based treatment regimen. However, the lack of standardization of imaging acquisition and analysis techniques for various perfusion MRI parameters needs to be resolved in the future. Despite these unsolved issues, the current evidence favoring the use of perfusion MRI as a predictive/prognostic or pharmacodynamic biomarker should be considered in patients with glioma treated using a bevacizumab-based regimen.
Collapse
|
14
|
Gunay M, Tuten A, Sancak S, Celik G, Bardak H, Dincer E, Karatekin G, Erdogan G, Bardak Y. Effect of Single Intravitreal Bevacizumab on Ophthalmic and Middle Cerebral Arterial Blood Flow in Retinopathy of Prematurity. Ophthalmic Res 2016; 55:165-71. [DOI: 10.1159/000443208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
|
15
|
Abstract
Individuals with glioblastoma are often characterized by older age, advanced neurologic manifestations at the primary stage, and unresectable tumors, and these factors are associated with poor treatment outcomes. Administration of bevacizumab (BV, Avastin®) promotes tumor regression and improves cerebral edema, and is expected to improve neurologic findings in many patients with malignant gliomas, including glioblastoma. Although the addition of BV to the conventional standard therapy (chemoradiotherapy with temozolomide) for newly diagnosed glioblastoma prolonged the progression-free survival time and the performance status of patients, it failed to extend overall survival time. However, more than 50% of glioblastoma patients show Karnofsky performance status ≤70 at initial presentation; therefore, BV should be used to improve or maintain their performance status as an initial treatment. Most of the adverse events of BV, except hypertension and proteinuria, occur as complications of glioblastoma, and explanation of the advantages and disadvantages of BV administration to patients is important. Herein, the efficacy, safety, and challenges of using BV for treating glioblastoma were reviewed.
Collapse
Affiliation(s)
- Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
16
|
Shiroishi MS, Boxerman JL, Pope WB. Physiologic MRI for assessment of response to therapy and prognosis in glioblastoma. Neuro Oncol 2015; 18:467-78. [PMID: 26364321 DOI: 10.1093/neuonc/nov179] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 08/01/2015] [Indexed: 02/06/2023] Open
Abstract
Aside from bidimensional measurements from conventional contrast-enhanced MRI, there are no validated or FDA-qualified imaging biomarkers for high-grade gliomas. However, advanced functional MRI techniques, including perfusion- and diffusion-weighted MRI, have demonstrated much potential for determining prognosis, predicting therapeutic response, and assessing early treatment response. They may also prove useful for differentiating pseudoprogression from true progression after temozolomide chemoradiation and pseudoresponse from true response after anti-angiogenic therapy. This review will highlight recent developments using these techniques and emphasize the need for technical standardization and validation in prospective studies in order for these methods to become incorporated into standard-of-care imaging for brain tumor patients.
Collapse
Affiliation(s)
- Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (M.S.S.); Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California (W.B.P.)
| | - Jerrold L Boxerman
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (M.S.S.); Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California (W.B.P.)
| | - Whitney B Pope
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (M.S.S.); Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California (W.B.P.)
| |
Collapse
|
17
|
Omar AI. Tumor treating field therapy in combination with bevacizumab for the treatment of recurrent glioblastoma. J Vis Exp 2014:e51638. [PMID: 25407354 PMCID: PMC4541554 DOI: 10.3791/51638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A novel device that employs TTF therapy has recently been developed and is currently in use for the treatment of recurrent glioblastoma (rGBM). It was FDA approved in April 2011 for the treatment of patients 22 years or older with rGBM. The device delivers alternating electric fields and is programmed to ensure maximal tumor cell kill1. Glioblastoma is the most common type of glioma and has an estimated incidence of approximately 10,000 new cases per year in the United States alone2. This tumor is particularly resistant to treatment and is uniformly fatal especially in the recurrent setting3-5. Prior to the approval of the TTF System, the only FDA approved treatment for rGBM was bevacizumab6. Bevacizumab is a humanized monoclonal antibody targeted against the vascular endothelial growth factor (VEGF) protein that drives tumor angiogenesis7. By blocking the VEGF pathway, bevacizumab can result in a significant radiographic response (pseudoresponse), improve progression free survival and reduce corticosteroid requirements in rGBM patients8,9. Bevacizumab however failed to prolong overall survival in a recent phase III trial26. A pivotal phase III trial (EF-11) demonstrated comparable overall survival between physicians’ choice chemotherapy and TTF Therapy but better quality of life were observed in the TTF arm10. There is currently an unmet need to develop novel approaches designed to prolong overall survival and/or improve quality of life in this unfortunate patient population. One appealing approach would be to combine the two currently approved treatment modalities namely bevacizumab and TTF Therapy. These two treatments are currently approved as monotherapy11,12, but their combination has never been evaluated in a clinical trial. We have developed an approach for combining those two treatment modalities and treated 2 rGBM patients. Here we describe a detailed methodology outlining this novel treatment protocol and present representative data from one of the treated patients.
Collapse
Affiliation(s)
- Ayman I Omar
- Southern Illinois University School of Medicine;
| |
Collapse
|
18
|
Takano S, Ishikawa E, Nakai K, Matsuda M, Masumoto T, Yamamoto T, Matsumura A. Bevacizumab in Japanese patients with malignant glioma: from basic research to clinical trial. Onco Targets Ther 2014; 7:1551-62. [PMID: 25228814 PMCID: PMC4161529 DOI: 10.2147/ott.s67621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
An antiangiogenic approach is especially suitable for the treatment of malignant gliomas. Recently, two large clinical trials in newly diagnosed glioblastoma (the Avastin in Glioblastoma study and Radiation Therapy Oncology Group 0825 study) showed a 3- to 4-month prolongation of progression-free survival (PFS) with bevacizumab, but no significant effect on overall survival (OS). Japan is the first, and so far only, country to approve the use of bevacizumab in newly diagnosed glioblastoma in combination with radiotherapy and temozolomide chemotherapy. The drug is also approved for use as monotherapy for recurrent glioblastoma and certain other types of high-grade glioma after previous therapy. The effectiveness of bevacizumab on Japanese malignant glioma patients was reviewed. The Phase II clinical trial demonstrated that the PFS with bevacizumab alone was 34% at 6 months and 3.3 months at median for 32 patients with recurrent malignant gliomas. In the Avastin in Glioblastoma study, 44 Japanese patients were registered from Japan. PFS and OS for bevacizumab combined with standard temozolomide and radiotherapy were 12.2 months and 29.2 months at median, respectively, for the patients with newly diagnosed glioblastoma. PFS and OS tended to be longer for those treated with bevacizumab than for those not treated with the drug. In addition, biomarkers of bevacizumab effectiveness were investigated in Japanese patients. Vascular endothelial growth factor concentration, matrix metalloproteinase 9 activities in urine, and apparent diffusion coefficient values on magnetic resonance imaging may be biomarkers that predict patient prognosis. Finally, novel experiments for vascular endothelial growth factor antibody action were described; these include the induction of glioma cell apoptosis, an antibody treatment failure model, and a study of the synergistic effect with chemotherapeutic agents.
Collapse
Affiliation(s)
- Shingo Takano
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kei Nakai
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomohiko Masumoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
19
|
Parametric response maps of perfusion MRI may identify recurrent glioblastomas responsive to bevacizumab and irinotecan. PLoS One 2014; 9:e90535. [PMID: 24675671 PMCID: PMC3968002 DOI: 10.1371/journal.pone.0090535] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/02/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Perfusion weighted imaging (PWI) can be used to measure key aspects of tumor vascularity in vivo and recent studies suggest that perfusion imaging may be useful in the early assessment of response to angiogenesis inhibitors. Aim of this work is to compare Parametric Response Maps (PRMs) with the Region Of Interest (ROI) approach in the analysis of tumor changes induced by bevacizumab and irinotecan in recurrent glioblastomas (rGBM), and to evaluate if changes in tumor blood volume measured by perfusion MRI may predict clinical outcome. METHODS 42 rGBM patients with KPS ≥ 50 were treated until progression, as defined by MRI with RANO criteria. Relative cerebral blood volume (rCBV) variation after 8 weeks of treatment was calculated through semi-automatic ROI placement in the same anatomic region as in baseline. Alternatively, rCBV variations with respect to baseline were calculated into the evolving tumor region using a voxel-by-voxel difference. PRMs were created showing where rCBV significantly increased, decreased or remained unchanged. RESULTS An increased blood volume in PRM (PRMCBV+) higher than 18% (first quartile) after 8 weeks of treatment was associated with increased progression free survival (PFS; 24 versus 13 weeks, p = 0.045) and overall survival (OS; 38 versus 25 weeks, p = 0.016). After 8 weeks of treatment ROI analysis showed that mean rCBV remained elevated in non responsive patients (4.8 ± 0.9 versus 5.1 ± 1.2, p = 0.38), whereas decreased in responsive patients (4.2 ± 1.3 versus 3.8 ± 1.6 p = 0.04), and re-increased progressively when patients approached tumor progression. CONCLUSIONS Our data suggest that PRMs can provide an early marker of response to antiangiogenic treatment and warrant further confirmation in a larger cohort of GBM patients.
Collapse
|