1
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Chiu TH, Tung PH, Huang CH, Ju JS, Huang ACC, Wang CC, Ko HW, Hsu PC, Fang YF, Guo YK, Kuo CHS, Yang CT. The different overall survival between single-agent EGFR-TKI treatment and with bevacizumab in non-small cell lung cancer patients with brain metastasis. Sci Rep 2022; 12:4398. [PMID: 35292755 PMCID: PMC8924189 DOI: 10.1038/s41598-022-08449-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Comparison of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) monotherapy or with bevacizumab in real-world non-small cell lung cancer (NSCLC) patients was lacking. 310 patients of advanced NSCLC with common EGFR mutation receiving first-generation EGFR-TKI monotherapy or with bevacizumab were included and propensity-score matched. Progression-free survival (PFS), overall survival (OS) and secondary T790M mutation were analysed. Patients receiving EGFR-TKI and bevacizumab were significantly younger, had better performance status and with high incidence of brain metastasis (55.8%). In the propensity-score matched cohort, PFS (13.5 vs. 13.7 months; log-rank p = 0.700) was similar between the two groups. The OS (61.3 vs. 34.2 months; log-rank p = 0.010) and risk reduction of death (HR 0.42 [95% CI 0.20–0.85]; p = 0.017) were significantly improved in EGFR-TKI plus bevacizumab group. Analysis of treatment by brain metastasis status demonstrated EGFR-TKI plus bevacizumab in patients with brain metastasis was associated with significant OS benefit compared to other groups (log-rank p = 0.030) and these patients had lower early-CNS and early-systemic progressions. The secondary T790M did not significantly differ between EGFR-TKI plus bevacizumab and EGFR-TKI monotherapy groups (66.7% vs. 75.0%, p = 0.460). Forty-one (31.1%) and 31 (23.5%) patients received subsequent osimertinib and chemotherapy, respectively. The post-progression OS of osimertinib and chemotherapy were 22.1 and 44.9 months in EGFR-TKI plus bevacizumab group and were 10.0 and 14.1 months in EGFR-TKI monotherpay group, respectively. First-generation EGFR-TKI with bevacizumab improved treatment efficacy in real-world patients of NSCLC with EGFR mutation. Patients with brain metastasis received additional OS benefit from this treatment.
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Affiliation(s)
- Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Pi-Hung Tung
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chi-Hsien Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Jia-Shiuan Ju
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ho-Wen Ko
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
| | - Yueh-Fu Fang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yi-Ke Guo
- Department of Computing, Data Science Institute, Imperial College London, London, UK
| | - Chih-Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan. .,Department of Computing, Data Science Institute, Imperial College London, London, UK.
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taipei, Taiwan
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2
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Wang B, Guo H, Xu H, Yu H, Chen Y, Zhao G. Research Progress and Challenges in the Treatment of Central Nervous System Metastasis of Non-Small Cell Lung Cancer. Cells 2021; 10:2620. [PMID: 34685600 PMCID: PMC8533870 DOI: 10.3390/cells10102620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/06/2021] [Accepted: 09/25/2021] [Indexed: 12/26/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors and has high morbidity and mortality rates. Central nervous system (CNS) metastasis is one of the most frequent complications in patients with NSCLC and seriously affects the quality of life (QOL) and overall survival (OS) of patients, with a median OS of untreated patients of only 1-3 months. There are various treatment methods for NSCLC CNS metastasis, including surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy, which do not meet the requirements of patients in terms of improving OS and QOL. There are still many problems in the treatment of NSCLC CNS metastasis that need to be solved urgently. This review summarizes the research progress in the treatment of NSCLC CNS metastasis to provide a reference for clinical practice.
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Affiliation(s)
- Bin Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, China; (B.W.); (H.X.); (H.Y.)
| | - Hanfei Guo
- Cancer Center, The First Hospital of Jilin University, Changchun 130021, China;
| | - Haiyang Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, China; (B.W.); (H.X.); (H.Y.)
| | - Hongquan Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, China; (B.W.); (H.X.); (H.Y.)
| | - Yong Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, China; (B.W.); (H.X.); (H.Y.)
| | - Gang Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, China; (B.W.); (H.X.); (H.Y.)
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3
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Steindl A, Berghoff AS. Brain metastases in metastatic cancer: a review of recent advances in systemic therapies. Expert Rev Anticancer Ther 2020; 21:325-339. [PMID: 33196341 DOI: 10.1080/14737140.2021.1851200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Brain metastases (BM) are a frequent complication of metastatic cancer. Due to the wider availability and application of screening procedures, an increasing fraction of patients are diagnosed at the asymptomatic stage. The introduction of immune checkpoint inhibitors and targeted therapies has revolutionized treatment in several frequently BM-causing entities like metastatic lung cancer, melanoma and breast cancer. However, registered trials of new targeted and immunotherapy mostly excluded patients with BM resulting in limited knowledge of the intracranial efficacy of new systemic agents.Areas covered: The present review highlights recent advances in systemic therapies for the treatment and prophylaxis of the three leading BM causing tumors: NSCLC, melanoma and breast cancer.Expert opinion: High intracranial efficacy was observed for several next-generation tyrosine kinase inhibitors as well as immune checkpoint inhibitors, especially in patients with asymptomatic disease. Ongoing discussions addressed the need for local therapies in patients with asymptomatic BM and the availability of systemic therapy with high intracranial efficacy. Further BM-specific studies as well as BM-specific endpoints in registered trials are needed to define the role of systemic monotherapies in patients with BM.
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Affiliation(s)
- Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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4
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Muto S, Ozaki Y, Okabe N, Matsumura Y, Hasegawa T, Shio Y, Hashimoto Y, Suzuki H. Successful Treatment of Combined Large Cell Neuroendocrine Carcinoma Harboring an EGFR Mutation with EGFR-TKIs plus Bevacizumab: A Case Report. Case Rep Oncol 2020; 13:1387-1392. [PMID: 33442360 PMCID: PMC7772843 DOI: 10.1159/000511112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023] Open
Abstract
Large cell neuroendocrine carcinoma (LCNEC) of the lung with epidermal growth factor receptor (EGFR) mutation is rare, and few cases have been treated with EGFR tyrosine kinase inhibitors (TKIs). We report the treatment of combined LCNEC with adenocarcinoma harboring an EGFR mutation with EGFR-TKIs and bevacizumab. Our patient was a 70-year-old asymptomatic woman who underwent surgical resection of the lung for combined LCNEC with adenocarcinoma harboring an activating EGFR mutation 11 months previously. Magnetic resonance imaging (MRI) and positron emission tomography revealed metastatic lesions in the brain and lung. The patient was diagnosed with recurrence of combined LCNEC with adenocarcinoma. The brain lesion was irradiated, followed by administration of afatinib. Eight months after irradiation, brain MRI revealed ringed enhancement and perilesional edema after radiotherapy without new metastatic lesions. We switched treatment to erlotinib and bevacizumab, resulting in maintenance of stable disease for 10 months. Overall, the disease was controlled for 18 months with EGFR-TKIs and bevacizumab. Combination treatment with EGFR-TKIs and bevacizumab could be a treatment option for LCNEC of the lung harboring EGFR mutations, especially with brain metastasis.
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Affiliation(s)
- Satoshi Muto
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yuki Ozaki
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Naoyuki Okabe
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yuki Matsumura
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Takeo Hasegawa
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yutaka Shio
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
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5
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Nintedanib and a bi-specific anti-VEGF/Ang2 nanobody selectively prevent brain metastases of lung adenocarcinoma cells. Clin Exp Metastasis 2020; 37:637-648. [PMID: 32918638 PMCID: PMC7666285 DOI: 10.1007/s10585-020-10055-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/06/2020] [Indexed: 02/07/2023]
Abstract
Brain metastases (BM) are an ever-increasing challenge in oncology, threatening quality of life and survival of many cancer patients. The majority of BM originate from lung adenocarcinoma, and stage III patients have a risk of 40–50% to develop BM in the first years of disease onset. As therapeutic options are limited, prevention of their occurrence is an attractive concept. Here we investigated whether Nintedanib (BIBF 1120), a tyrosine kinase inhibitor (TKI) targeting the VEGF pathway approved for lung adenocarcinoma, and the dual anti-VEGF-A/Ang2 nanobody BI836880 have the potential to prevent BM formation. A mouse model of brain metastasis from lung adenocarcinoma was used in which tumor cells were injected intracardially. Metastases formation occurred inside and outside of the brain and was followed by MRI, IVIS, and immunohistochemistry. BM were reduced in volume and number by both Nintedanib and the dual anti-VEGF-A/Ang2 nanobody, which translated into improved survival. Both compounds were able to normalize cerebral blood vessels at the site of brain metastatic lesions. Extracranial metastases, however, were not reduced, and meningeal metastases only partially. Interestingly, unspecific control IgG also lead to brain vessel normalization and reduction of brain and meningeal metastases. This data indicates a brain-specific group effect of antiangiogenic compounds with respect to metastasis prevention, most likely by preventing an early angiogenic switch. Thus, Nintedanib and BI836880 are promising candidates for future BM preventive study concepts in lung adenocarcinoma patients.
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6
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Liang P, Wang YD, Wei ZM, Deng QJ, Xu T, Liu J, Luo N, Hou J. Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis. Open Med (Wars) 2020; 15:589-597. [PMID: 33313410 PMCID: PMC7706125 DOI: 10.1515/med-2020-0192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
This study evaluates the efficacy and safety of bevacizumab (BEV) in the treatment of non-small cell lung cancer (NSCLC) patients with brain metastases (BM) by performing meta-analyses of response and survival indices. Seventeen studies were included. BEV treatment was associated with a lower new BM incidence (hazard ratio: 0.30 [95% confidence interval (CI): 0.14, 0.46]) during follow-up. Disease control rate (DCR) of BEV-treated patients with BM was 91% [95% CI: 85, 95]. However, intracranial DCR was relatively higher (94% [95% CI: 87, 98]) than extracranial DCR (86% [95% CI: 74, 96]). DCR of NSCLC patients with BM was significantly better with BEV than with control therapies (odds ratio: 2.71 [95% CI: 1.26, 5.86], P = 0.01). Progression-free survival (PFS) of BEV-treated patients with and without BM was 7.1 months [95% CI: 6.2, 8.0] and 7.4 months [95% CI: 6.3, 8.4], respectively. Intracranial PFS of BEV-treated patients with BM was 8.0 months [95% CI: 6.0, 10.0]. Overall survival of BEV-treated NSCLC patients with and without BM was 13.5 months [95% CI: 11.4, 15.6] and 12.5 months [95% CI: 10.2, 14.8], respectively. The incidence of bleeding/hemorrhage in the central nervous system was 1% with BEV treatment.
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Affiliation(s)
- Ping Liang
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Yu-Dong Wang
- Department of Oncology, Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Zong-Min Wei
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Qi-Jun Deng
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Tong Xu
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Jiang Liu
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
| | - Na Luo
- Department of Science and Technology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Juan Hou
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, No. 169, Tianshan Street, Shijiazhuang, Hebei 050011, China
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7
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Masuda C, Sugimoto M, Wakita D, Monnai M, Ishimaru C, Nakamura R, Kinoshita M, Yorozu K, Kurasawa M, Kondoh O, Yamamoto K. Bevacizumab suppresses the growth of established non-small-cell lung cancer brain metastases in a hematogenous brain metastasis model. Clin Exp Metastasis 2020; 37:199-207. [PMID: 31768815 PMCID: PMC7007905 DOI: 10.1007/s10585-019-10008-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/15/2019] [Indexed: 11/08/2022]
Abstract
Brain metastases are common in patients with non-small-cell lung cancer (NSCLC). The efficacy of bevacizumab, an anti-vascular endothelial growth factor (VEGF) humanized antibody, has been demonstrated in patients with nonsquamous NSCLC. We established a transplantable NSCLC cell line (Nluc-H1915) that stably expresses NanoLuc® reporter and confirmed the correlation between total Nluc activity in tumor and tumor volume in vivo. SCID mice inoculated with these cells through the internal carotid artery formed reproducible brain metastases, in which human VEGF was detected. Next, after metastases were established in the model mice (15-17 days), they were intraperitoneally administered weekly doses of human immunoglobulin G (HuIgG) or bevacizumab. Nluc activity in the brain was significantly lower in bevacizumab-treated mice than in HuIgG-treated mice. Additionally, bevacizumab concentration in the brain was higher in mice with brain metastasis than in normal mice, and bevacizumab was primarily observed in brain metastasis lesions. The microvessel density in brain metastasis was lower in bevacizumab-treated mice than in HuIgG-treated mice. We believe bevacizumab's anti-proliferative effect on brain metastasis is due to anti-angiogenic activity achieved by its penetration into brain metastases; this suggests that a bevacizumab-containing regimen may be a promising treatment option for patients with NSCLC brain metastasis.
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Affiliation(s)
- Chinami Masuda
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Masamichi Sugimoto
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan.
| | - Daiko Wakita
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Makoto Monnai
- Chugai Research Institute for Medical Science Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Chisako Ishimaru
- Chugai Research Institute for Medical Science Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Ryo Nakamura
- Chugai Research Institute for Medical Science Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Mari Kinoshita
- Chugai Research Institute for Medical Science Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Keigo Yorozu
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Mitsue Kurasawa
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Osamu Kondoh
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Kaname Yamamoto
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
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8
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Chen J, Wang J, Zheng Q, Weng M, Wu X. Radiologic Complete Response In Lung Adenocarcinoma With Symptomatic Brain Metastasis After Systematic Therapy: A Case Study. Onco Targets Ther 2019; 12:9551-9557. [PMID: 31814730 PMCID: PMC6858604 DOI: 10.2147/ott.s226735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
Abstract
Patients diagnosed as lung adenocarcinoma with brain metastasis usually result in poor prognosis with limited survival time. Palliative systematic therapy has emerged as the primary choice for non-small cell lung cancer patients with brain metastasis harboring wild-type drive genes. However, the objective response rate and long-term survival for patients treated with this therapy remained unsatisfied. Herein, we present a case with lung adenocarcinoma accompanied with symptomatic brain metastasis who achieved radiologic complete response after receiving combined therapy including stereotactic body radiation therapy, anti-angiogenesis, and chemotherapy. He has achieved a duration of disease-free survival of thirty-six months, and is still in extension.
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Affiliation(s)
- Jianxin Chen
- Department of Medical Oncology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, People's Republic of China
| | - Junhui Wang
- Department of Radiation Oncology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, People's Republic of China
| | - Qinhong Zheng
- Department of Medical Oncology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, People's Republic of China
| | - Meiling Weng
- Department of Medical Oncology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, People's Republic of China
| | - Xilin Wu
- Department of Medical Oncology, Quzhou People's Hospital, Quzhou, Zhejiang 324000, People's Republic of China
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9
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Tian Y, Zhai X, Tian H, Jing W, Zhu H, Yu J. Bevacizumab in Combination with Pemetrexed and Platinum Significantly Improved the Clinical Outcome of Patients with Advanced Adenocarcinoma NSCLC and Brain Metastases. Cancer Manag Res 2019; 11:10083-10092. [PMID: 31819641 PMCID: PMC6890207 DOI: 10.2147/cmar.s222910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background The study aims to evaluate the clinical efficacy and safety of bevacizumab in combination with the first-line pemetrexed-platinum (PP) in patients with advanced adenocarcinoma non-small-cell lung cancer (NSCLC) and brain metastases. Methods The clinical data of patients with adenocarcinoma NSCLC and symptomatic or asymptomatic brain metastases were collected in our study. The basic chemotherapy regimen was pemetrexed-platinum (PP). According to whether combined with bevacizumab (B) or not, all enrolled patients were assigned to the B+PP group or the PP alone group. Results A total of 71 patients were enrolled in the current study. Twenty-six patients were allocated to the B+PP group and 45 were allocated to the PP group. Overall response rates (ORRs), disease control rates (DCRs) of the thoracic tumors and intracranial metastases and overall survival (OS) were not significantly different between the 2 groups. However, progression-free survival (PFS) and intracranial PFS (iPFS) were significantly prolonged in the B+PP group compared with the PP group. The median PFS was 9.2 and 8.2 months, and the 1-year PFS rates were 47.1% and 15.9%, respectively, in the 2 groups (P=0.029). And, the median iPFS were 24.3 and 10.9 months, and the 1-year iPFS rates were 80.1% and 40.1%, respectively, in the 2 groups (P=0.008). Univariate and multivariate analyses suggested that maintenance therapy and bevacizumab therapy were independent favorable prognostic factors of PFS and iPFS. Conclusion The addition of bevacizumab to the first-line pemetrexed and platinum significantly improved clinical outcomes of patients with advanced adenocarcinoma NSCLC and brain metastases.
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Affiliation(s)
- Yaru Tian
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Xiaoyang Zhai
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
| | - Hairong Tian
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Wang Jing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
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10
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Ascha MS, Wang JF, Kumthekar P, Sloan AE, Kruchko C, Barnholtz-Sloan JS. Bevacizumab for the treatment of non-small cell lung cancer patients with synchronous brain metastases. Sci Rep 2019; 9:17792. [PMID: 31780762 PMCID: PMC6882803 DOI: 10.1038/s41598-019-54513-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/15/2019] [Indexed: 12/20/2022] Open
Abstract
Bevacizumab is FDA-approved in the treatment of primary brain tumors, but its efficacy in patients with brain metastases could be better-studied. This study examines a population of non-small cell lung cancer (NSCLC) patients with synchronous brain metastases to identify predictors of the decision to use bevacizumab and survival following bevacizumab treatment. Primary cancer registry data were used to determine which NSCLC patients diagnosed in the years 2010 through 2012 had synchronous brain metastases at the time of diagnosis, and Medicare claims used to identify a population of patients treated with bevacizumab. Record of bevacizumab treatment was found for 81 and 666 patients with and without brain metastases, respectively. After adjusting for clinical and demographic characteristics, bevacizumab was associated with 0.88 times the hazard of mortality in the elderly NSCLC population (95% CI: 0.81–0.96, p: 0.003) and a corresponding hazard ratio of 0.75 in the population of elderly NSCLC patients with synchronous brain metastases (95% CI: 0.59–0.96, p: 0.020). Bevacizumab may benefit NSCLC patients with synchronous brain metastases more than it does patients without intracranial disease, possibly as a result of its multiple potential mechanisms of action simultaneously inhibiting angiogenesis and minimizing vasogenic edema.
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Affiliation(s)
- Mustafa S Ascha
- Center for Clinical Investigation, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Priya Kumthekar
- Northwestern University Feinberg School of Medicine, Department of Neurology, Evanston, Illinois, USA
| | - Andrew E Sloan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Seidman Cancer Center, and the Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jill S Barnholtz-Sloan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. .,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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11
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Zhan Q, Miao F, Huang R, Zhou X, Ge M, Liang X. Efficacy and safety of bevacizumab combined with chemotherapy in symptomatic brain metastases from lung adenocarcinoma: a retrospective analysis. J Thorac Dis 2019; 11:4725-4734. [PMID: 31903262 DOI: 10.21037/jtd.2019.10.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Currently, the treatment of symptomatic brain metastases from lung adenocarcinoma has remained difficult. Bevacizumab combined with chemotherapy is one of the standard treatments of lung adenocarcinoma. This study was designed to investigate the efficacy and safety of bevacizumab combined with chemotherapy in symptomatic brain metastases from lung adenocarcinoma that are not suitable for local treatments, and to explore the predictive value of baseline serum vascular endothelial growth factor (VEGF) for the treatment. Methods We retrospectively reviewed 14 consecutive patients, between Jan 2015 and Jul 2017, with brain metastases from lung adenocarcinoma who received bevacizumab and chemotherapy to determine efficacy and toxicity. Kaplan-Meier method was used to estimate survival curves, and univariate and multivariate analyses were performed by Cox proportional hazard model. The primary endpoints were objective response rate (ORR) and intracranial ORR (iORR). The secondary endpoints were progression-free survival (PFS), intracranial PFS (iPFS), overall survival (OS) and disease control rate (DCR). Results The efficacy of 12 patient was evaluated. Overall ORR was 25% (3/12) and the iORR of brain lesions was 33.3% (4/12). DCR was 75% (9/12). The median OS was 18.3 months, the median PFS was 6.7 months, and the median iPFS was 12 months. After 2 cycles of bevacizumab, 10 patients showed improved symptoms of central nervous system (CNS), and the symptom control rate was 83.3% (10/12). Head MRI showed that edema in the brain was greatly reduced in 6 patients, resulting in the lessened usage of dexamethasone. iPFS was significantly shorter in high VEGF group (3.6 vs. 8.0 m, P=0.02), and multivariate analysis showed a significant correlation between iPFS and serum baseline VEGF level (P=0.023). The most commonly adverse events of bevacizumab included leukopenia [5 (35.7%)], fatigue [3 (21.4%)], thrombocytopenia [3 (21.4%)], anemia [2 (14.3%)], which were mostly degree I and II. Conclusions This study showed bevacizumab combined with chemotherapy could effectively control intracranial lesions, relieve symptoms, and improve the quality of life and survival of patients with brain metastases from lung adenocarcinoma. Serum baseline VEGF may be a predictor of efficacy of bevacizumab plus chemotherapy in the treatment of brain metastases from lung adenocarcinoma.
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Affiliation(s)
- Qiong Zhan
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Feng Miao
- Department of Thoracic Surgery, Huashan Hospital North, Fudan University, Shanghai 200040, China
| | - Ruofan Huang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xinli Zhou
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mengxi Ge
- Department of Thoracic Surgery, Huashan Hospital North, Fudan University, Shanghai 200040, China
| | - Xiaohua Liang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
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12
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Abstract
Patients with brain tumor encounter a wide spectrum of tumor and treatment-related complications during their disease course. Tumors may serve as seizure substrates, are associated with a hypercoagulable state that results in thromboembolic complications, and may influence mood and cognition. Antitumor and supportive therapies may also have deleterious effects. Herein, we discuss major aspects of supportive care for patients with brain tumors, with attention to benefit and complications derived from the management of seizures, brain edema, venous thromboembolism, fatigue, mood alterations, and cognitive dysfunction.
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Affiliation(s)
- Kester A Phillips
- Department of Neuroscience, Inova Health System, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Camilo E Fadul
- Division of Neuro-Oncology, University of Virginia Health System, 1300 Jefferson Park Avenue, West Complex, Room 6228, Charlottesville, VA 22903-0156, USA
| | - David Schiff
- Division of Neuro-Oncology, University of Virginia Health System, 1300 Jefferson Park Avenue, West Complex, Room 6225, Charlottesville, VA 22903-0156, USA.
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13
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Gubens MA, Chuang JC, Akerley W, Langer CJ, Clément-Duchêne C, San Pedro-Salcedo M, Colevas AD, Dragnev K, Socinski MA, Wakelee HA. A pooled analysis of advanced nonsquamous non-small cell lung cancer patients with stable treated brain metastases in two phase II trials receiving bevacizumab and pemetrexed as second-line therapy. J Thorac Dis 2018; 10:219-227. [PMID: 29600052 DOI: 10.21037/jtd.2017.12.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Brain metastases are a common complication of advanced non-small cell lung cancer (NSCLC). Patients with brain metastases were excluded from the registration trials of bevacizumab that showed a survival benefit with the use of angiogenesis inhibition. Methods In this study, we pooled data from two separate trials designed to evaluate the risk of central nervous system (CNS) hemorrhage in patients with stable treated brain metastases to look specifically at both the safety and efficacy of bevacizumab and pemetrexed when used as second-line treatment in NSCLC patients with stable treated brain metastases. Results We report acceptable safety and promising efficacy from our analysis. Conclusions Our study adds further evidence of safety of administering pemetrexed and bevacizumab to patients with stable brain metastases. There is increasing roles for systemic therapies to treat stable brain metastases for patients with advanced NSCLC.
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Affiliation(s)
- Matthew A Gubens
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jody C Chuang
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Wallace Akerley
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Corey J Langer
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - A Dimitrios Colevas
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Konstantin Dragnev
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
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14
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Yang RF, Yu B, Zhang RQ, Wang XH, Li C, Wang P, Zhang Y, Han B, Gao XX, Zhang L, Jiang ZM. Bevacizumab and gefitinib enhanced whole-brain radiation therapy for brain metastases due to non-small-cell lung cancer. ACTA ACUST UNITED AC 2017; 51:e6073. [PMID: 29185589 PMCID: PMC5685055 DOI: 10.1590/1414-431x20176073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/02/2017] [Indexed: 12/16/2022]
Abstract
Non-small-cell lung cancer (NSCLC) patients who experience brain metastases are usually associated with poor prognostic outcomes. This retrospective study proposed to assess whether bevacizumab or gefitinib can be used to improve the effectiveness of whole brain radiotherapy (WBRT) in managing patients with brain metastases. A total of 218 NSCLC patients with multiple brain metastases were retrospectively included in this study and were randomly allocated to bevacizumab-gefitinib-WBRT group (n=76), gefitinib-WBRT group (n=77) and WBRT group (n=75). Then, tumor responses were evaluated every 2 months based on Response Evaluation Criteria in Solid Tumors version 1.0. Karnofsky performance status and neurologic examination were documented every 6 months after the treatment. Compared to the standard WBRT, bevacizumab and gefitinib could significantly enhance response rate (RR) and disease control rate (DCR) of WBRT (P<0.001). At the same time, RR and DCR of patients who received bevacizumab-gefitinib-WBRT were higher than those who received gefitinib-WBRT. The overall survival (OS) rates and progression-free survival (PFS) rates also differed significantly among the bevacizumab-gefitinib-WBRT (48.6 and 29.8%), gefitinib-WBRT (36.7 and 29.6%) and WBRT (9.8 and 14.6%) groups (P<0.05). Although bevacizumab-gefitinib-WBRT was slightly more toxic than gefitinib-WBRT, the toxicity was tolerable. As suggested by prolonged PFS and OS status, bevacizumab substantially improved the overall efficacy of WBRT in the management of patients with NSCLC.
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Affiliation(s)
- R F Yang
- Department of Thoracic Surgery, Qianfoshan Hospital of Shandong Province, Shandong University, Ji'nan, Shandong, China.,Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - B Yu
- Department of Anus and Intestine Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - R Q Zhang
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - X H Wang
- Department of Digestive System, Taian City Central Hospital, Taian, Shandong, China
| | - C Li
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - P Wang
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - Y Zhang
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - B Han
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - X X Gao
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - L Zhang
- Department of Thoracic Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - Z M Jiang
- Department of Thoracic Surgery, Qianfoshan Hospital of Shandong Province, Shandong University, Ji'nan, Shandong, China
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15
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Paradigm shift of therapeutic management of brain metastases in EGFR-mutant non-small cell lung cancer in the era of targeted therapy. Med Oncol 2017; 34:121. [PMID: 28555261 DOI: 10.1007/s12032-017-0978-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations commonly present brain metastases (BM) at the time of NSCLC diagnosis or during the clinical course. Conventionally, the prognosis of BM has been extremely poor, but the advent of EGFR-tyrosine kinase inhibitors (TKIs) has drastically improved the prognosis in these patients. Despite the presence of the blood-brain barrier, EGFR-TKIs have dramatic therapeutic effects on both BM and extracranial disease. In addition, recent systemic chemotherapies reportedly play a role in controlling BM. These treatment modalities can potentially replace whole brain radiotherapy (WBRT) to prevent or delay neurocognitive decline. Therefore, how to utilize these treatments is one issue. The other issue is what kind of treatment is best for recurrence after TKI therapy. Recent reports have shown a positive effect of a combination therapy of EGFR-TKI and radiotherapy on BM. Although neurocognitive decline is underscored when WBRT is considered, a survival benefit from WBRT has been proven especially in the potential long survivors with good prognostic index, especially disease-specific graded prognostic index (DS-GPA). In this review, treatment strategy including chemotherapeutic agents and radiotherapy is discussed in terms of risk-benefit balance in conjunction with DS-GPA.
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16
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Abbasi S, Moussaly E, Atallah JP. Leptomeningeal Carcinomatosis in Recurrent Non-Small Cell Lung Cancer: A Case Report and Review of Current Treatment Modalities. Cureus 2017; 9:e1242. [PMID: 28620571 PMCID: PMC5467982 DOI: 10.7759/cureus.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Leptomeningeal carcinomatosis (LC) is an uncommon sequelae of non-small cell lung cancer. The treatment modalities for LC have historically been limited with an overall poor prognosis. This case report outlines a 76-year-old female who presented with recurrence of non-small cell lung cancer as LC. LC is difficult to treat, and options include radiation, chemotherapy (systemic and intrathecal), as well as targeted therapies. This case outlines a unique approach and reviews the current literature on the effectiveness of these options in non-small cell lung cancer.
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Affiliation(s)
- Saqib Abbasi
- Internal Medicine, Staten Island University Hospital
| | | | - Jean P Atallah
- Hematology / Oncology, Staten Island University Hospital
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17
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Shi Y, Sun Y, Yu J, Ding C, Ma Z, Wang Z, Wang D, Wang Z, Wang M, Wang Y, Lu Y, Ai B, Feng J, Liu Y, Liu X, Liu J, Wu G, Qu B, Li X, Li E, Li W, Song Y, Chen G, Chen Z, Chen J, Yu P, Wu N, Wu M, Xiao W, Xiao J, Zhang L, Zhang Y, Zhang Y, Zhang S, Song X, Luo R, Zhou C, Zhou Z, Zhao Q, Hu C, Hu Y, Nie L, Guo Q, Chang J, Huang C, Han B, Han X, Li G, Huang Y, Shi Y. [China Experts Consensus on the Diagnosis and Treatment of Brain Metastases of Lung Cancer (2017 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:1-13. [PMID: 28103967 PMCID: PMC5973287 DOI: 10.3779/j.issn.1009-3419.2017.01.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuankai Shi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Yan Sun
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Jinming Yu
- Shandong Province Cancer Hospital, 250117 Jinan, China
| | - Cuimin Ding
- The Fourth Hospital of Hebei Medical University, 050000 Shijiazhuang, China
| | - Zhiyong Ma
- Henan Province Cancer Hospital, 450008 Zhengzhou, China
| | - Ziping Wang
- Beijing Cancer Hospital, 100142 Beijing, China
| | - Dong Wang
- Daping Hospital, Third Military Medical University, 400042 Chongqing, China
| | - Zheng Wang
- National Center for Geriatric Medicine/Beijing Hospital, 100730 Beijing, China
| | - Mengzhao Wang
- Peking Union Medical College Hospital, 100730 Beijing, China
| | - Yan Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - You Lu
- West China Hospital of Sichuan University, 610041 Chengdu, China
| | - Bin Ai
- National Center for Geriatric Medicine/Beijing Hospital, 100730 Beijing, China
| | - Jifeng Feng
- Jiangsu Cancer Hospital, 210009 Nanjing, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, 110001 Shenyang, China
| | - Xiaoqing Liu
- The 307th Hospital of Chinese People's Liberation Army, 100071 Beijing, China
| | - Jiwei Liu
- The First Affiliated Hospital of Dalian Medical University, 116011 Dalian, China
| | - Gang Wu
- Huazhong University of Science and Technology Union Hospital, 430022 Wuhan, China
| | - Baolin Qu
- Chinese People's Liberation Army General Hospital, 100853 Beijing, China
| | - Xueji Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi 'an Jiaotong University, 710061 Xi'an, China
| | - Wei Li
- The First Hospital of Jilin University, 130021 Changchun, China
| | - Yong Song
- Nanjing General Hospital, 210002 Nanjing, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, 150081 Harbin, China
| | - Zhengtang Chen
- Xinqiao Hospital of Third Military medical University, 400037 Chongqing, China
| | - Jun Chen
- The Second Hospital of Dalian Medical University, 116027 Dalian, China
| | - Ping Yu
- Sichuan Cancer Hospital, 610047 Chengdu, China
| | - Ning Wu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Milu Wu
- Qinghai University Affiliated Cancer Hospital, 810000 Xining, China
| | - Wenhua Xiao
- The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, 100048 Beijing, China
| | - Jianping Xiao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Li Zhang
- Peking Union Medical College Hospital, 100730 Beijing, China
| | - Yang Zhang
- The Second Hospital of Dalian Medical University, 116027 Dalian, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, 310022 Hangzhou, China
| | - Shucai Zhang
- Beijing Chest Hospital, Capital Medical University, 101149 Beijing, China
| | - Xia Song
- Shanxi Province Cancer Hospital, 030013 Taiyuan, China
| | - Rongcheng Luo
- TCM-Integrated Cancer Center of Southern Medical University, 510315 Guangzhou, China
| | - Caicun Zhou
- Tongji University Affiliated Shanghai Pulmonary Hospital, 200433 Shanghai, China
| | - Zongmei Zhou
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Qiong Zhao
- The First Affiliated Hospital, Zhejiang University, 310003 Hangzhou, China
| | - Chengping Hu
- Xiangya Hospital Central South University, 410008 Changsha, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, 100853 Beijing, China
| | - Ligong Nie
- Peking University First Hospital, 100034 Beijing, China
| | - Qisen Guo
- The Fourth Hospital of Hebei Medical University, 050000 Shijiazhuang, China
| | - Jianhua Chang
- Fudan Universitay Shanghai Cancer Center, 200032 Shanghai, China
| | - Cheng Huang
- Fujian Cancer Hospital, 350014 Fuzhou, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, 200030 Shanghai, China
| | - Xiaohong Han
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Gong Li
- General Hospital of Armed Police, 100039 Beijing, China
| | - Yu Huang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Youwu Shi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
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18
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Liu MC, Cortés J, O'Shaughnessy J. Challenges in the treatment of hormone receptor-positive, HER2-negative metastatic breast cancer with brain metastases. Cancer Metastasis Rev 2017; 35:323-32. [PMID: 27023712 DOI: 10.1007/s10555-016-9619-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brain metastases are a major cause of morbidity and mortality for women with hormone receptor (HR)-positive breast cancer, yet little is known about the optimal treatment of brain disease in this group of patients. Although these patients are at lower risk for brain metastases relative to those with HER2-positive and triple-negative disease, they comprise the majority of women diagnosed with breast cancer. Surgery and radiation continue to have a role in the treatment of brain metastases, but there is a dearth of effective systemic therapies due to the poor penetrability of many systemic drugs across the blood-brain barrier (BBB). Additionally, patients with brain metastases have long been excluded from clinical trials, and few studies have been conducted to evaluate the safety and effectiveness of systemic therapies specifically for the treatment of HER2-negative breast cancer brain metastases. New approaches are on the horizon, such as nanoparticle-based cytotoxic drugs that have the potential to cross the BBB and provide clinically meaningful benefits to patients with this life-threatening consequence of HR-positive breast cancer.
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Affiliation(s)
- Minetta C Liu
- Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain
- Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Joyce O'Shaughnessy
- Baylor-Sammons Cancer Center, Texas Oncology, U.S. Oncology, Dallas, TX, USA
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19
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Cedrych I, Kruczała MA, Walasek T, Jakubowicz J, Blecharz P, Reinfuss M. Systemic treatment of non-small cell lung cancer brain metastases. Contemp Oncol (Pozn) 2016; 20:352-357. [PMID: 28373815 PMCID: PMC5371701 DOI: 10.5114/wo.2016.64593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/27/2015] [Indexed: 12/02/2022] Open
Abstract
In the systemic treatment of brain metastases from non-small cell lung cancer (BMF-NSCLC) chemo- and targeted therapy are used. Response rates after platinum-based chemotherapy, range from 23% to 45%. Development of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs): gefitinib or erlotinib, was an improvement in treatment of advanced NSCLC patients. EGFR mutations are present in 10-25% of NSCLC (mostly adenocarcinoma), and up to 55% in never-smoking women of East Asian descent. In the non-selected group of patients with BMF-NSCLC, the overall response rates after gefitinib or erlotinib treatment range from 10% to 38%, and the duration of response ranges from 9 to 13.5 months. In the case of present activating EGFR mutation, the response rate after EGRF-TKIs is greater than 50%, and in selected groups (adenocarcinoma, patients of Asian descent, never-smokers, asymptomatic BMF-NSCLC) even 70%. Gefitinib or erlotinib treatment improves survival of BMF-NSCLC patients with EGFR mutation in comparison to cases without the presence of this mutation. There is no data on the activity of the anti-EML4-ALK agent crizotinib. Bevacizumab, recombinant humanised monoclonal antibody anti-VEGF, in the treatment of advanced non-squamous NSCLC patients is a subject of intense research. Data from a clinical trial enrolling patients with pretreated or occult BMF-NSCLC proved that the addition of bevacizumab to various chemotherapy agents or erlotinib is a safe and efficient treatment, associated with a low incidence of CSN haemorrhages. However, the efficacy and safety of bevacizumab used for therapeutic intent, regarding active brain metastases is unknown.
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Affiliation(s)
- Ida Cedrych
- Department of Systemic and Generalised Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Maksymilian A. Kruczała
- Department of Systemic and Generalised Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Tomasz Walasek
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Jerzy Jakubowicz
- Department of Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Paweł Blecharz
- Department of Gynecologic Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Marian Reinfuss
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
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20
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Buttigliero C, Bertaglia V, Novello S. Anti-angiogenetic therapies for central nervous system metastases from non-small cell lung cancer. Transl Lung Cancer Res 2016; 5:610-627. [PMID: 28149756 DOI: 10.21037/tlcr.2016.09.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Central nervous system (CNS) metastases are common in patients with advanced non-small cell lung cancer (NSCLC), occurring in 24% to 44% of patients in the course of their disease and confer significant morbidity and mortality. Systemic therapies have been deemed ineffective in brain metastases (BM) under the hypothesis that the blood-brain barrier (BBB) limits their delivery to the brain. Angiogenesis, which is mainly mediated by vascular endothelial growth factor (VEGF) pathway, is crucial for tumor survival, growth and invasion both in primary and metastatic brain lesions. Two major categories of agents have been developed to target this pathway: antibody-based agents and VEGF receptor tyrosine kinase inhibitors (TKIs). Clinical benefits have been shown with anti-angiogenetic therapies in the treatment of metastatic NSCLC. However, patients with CNS metastases were often excluded from trials with these agents, due to concerns about a potentially greater risk of cerebral haemorrhage and thromboembolic disease. Therefore, the overall efficacy and safety of angiogenetic agents in patients with BM from NSCLC are yet to be clarified. This paper aims to review available data about the efficacy and safety of anti-angiogenetic therapies for CNS metastases in NSCLC patients.
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Affiliation(s)
- Consuelo Buttigliero
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Valentina Bertaglia
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Silvia Novello
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
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21
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Qu L, Geng R, Song X. [Advances in Bevacizumab Therapy for Non-small Cell Lung Cancer
with Brain Metastases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:515-8. [PMID: 27561800 PMCID: PMC5972979 DOI: 10.3779/j.issn.1009-3419.2016.08.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Brain metastases are frequently encountered in patients with non-small cell lung cancer (NSCLC) and are a significant cause of morbidity and mortality. Antiangiogenesis therapy plays a major role in the management of brain metastases in lung cancer. Bevacizumab have become the novel method for the treatment of lung cancer with brain metastases beyond the whole brain radiation therapy, stereotactic radiosurgery and chemotherapy. Recently, more and more studies and trials laid emphasis on the bevacizumab for NSCLC with brain metastases treatment. The key point is the efficacy and safety. In this review, bevacizumab therapy of NSCLC with brain metastases were summarized.
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Affiliation(s)
- Liyan Qu
- Department of Pulmonary Oncology, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Rui Geng
- Department of Pulmonary Oncology, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Xia Song
- Department of Pulmonary Oncology, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
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22
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Fu Y, Hu J, Du N, Jiao S, Li F, Li X, Ma J, Zhao H, Kang H. Bevacizumab plus chemotherapy versus chemotherapy alone for preventing brain metastasis derived from advanced lung cancer. J Chemother 2016; 28:218-24. [DOI: 10.1179/1973947815y.0000000045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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23
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Burger MC, Zeiner PS, Jahnke K, Wagner M, Mittelbronn M, Steinbach JP. Addition of Anti-Angiogenetic Therapy with Bevacizumab to Chemo- and Radiotherapy for Leptomeningeal Metastases in Primary Brain Tumors. PLoS One 2016; 11:e0155315. [PMID: 27253224 PMCID: PMC4890753 DOI: 10.1371/journal.pone.0155315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022] Open
Abstract
Leptomeningeal dissemination of a primary brain tumor is a condition which is challenging to treat, as it often occurs in rather late disease stages in highly pretreated patients. Its prognosis is dismal and there is still no accepted standard of care. We report here a good clinical effect with a partial response in three out of nine patients and a stable disease with improvement on symptoms in two more patients following systemic anti-angiogenic treatment with bevacizumab (BEV) alone or in combination with chemo- and/or radiotherapy in a series of patients with leptomeningeal dissemination from primary brain tumors (diffuse astrocytoma WHO°II, anaplastic astrocytoma WHO°III, anaplastic oligodendroglioma WHO°III, primitive neuroectodermal tumor and glioblastoma, both WHO°IV). This translated into effective symptom control in five out of nine patients, but only moderate progression-free and overall survival times were reached. Partial responses as assessed by RANO criteria were observed in three patients (each one with anaplastic oligodendroglioma, primitive neuroectodermal tumor and glioblastoma). In these patients progression-free survival (PFS) intervals of 17, 10 and 20 weeks were achieved. In three patients (each one with diffuse astrocytoma, anaplastic astrocytoma and primitive neuroectodermal tumor) stable disease was observed with PFS of 13, 30 and 8 weeks. Another three patients (all with glioblastoma) were primary non-responders and deteriorated rapidly with PFS of 3 to 4 weeks. No severe adverse events were seen. These experiences suggest that the combination of BEV with more conventional therapy schemes with chemo- and/or radiotherapy may be a palliative treatment option for patients with leptomeningeal dissemination of brain tumors.
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Affiliation(s)
- Michael C. Burger
- Dr. Senckenberg Institute of Neurooncology, Goethe University, Frankfurt, Germany
- * E-mail:
| | - Pia S. Zeiner
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany
- Department of Neurology, Goethe University, Frankfurt, Germany
| | - Kolja Jahnke
- Department of Neurology, Goethe University, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University, Frankfurt, Germany
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany
| | - Joachim P. Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University, Frankfurt, Germany
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24
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Hanibuchi M, Kim SJ, Fidler IJ, Nishioka Y. The molecular biology of lung cancer brain metastasis: an overview of current comprehensions and future perspectives. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 61:241-53. [PMID: 25264041 DOI: 10.2152/jmi.61.241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Brain metastases occur in 20-40% of patients with advanced malignancies and lung cancer is one of the most common causes of brain metastases. The occurrence of brain metastases is associated with poor prognosis and high morbidity in patients with advanced lung cancer, even after intensive multimodal therapy. Progress in treating brain metastases has been hampered by a lack of model systems, a lack of human tissue samples, and the exclusion of brain metastatic patients from many clinical trials. While the biology of brain metastasis is still poorly understood, it is encouraging to see more efforts are beginning to be directed toward the study of brain metastasis. During the multi-step process of metastasis, functional significance of gene expressions, changes in brain vasculature, abnormal secretion of soluble factors and activation of autocrine/paracrine signaling are considered to contribute to the brain metastasis development. A better understanding of the mechanism of this disease will help us to identify the appropriate therapeutic strategies, which leads to circumvent brain metastases. Recent findings on the biology of lung cancer brain metastases and translational leads identified by molecular studies are discussed in this review.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Respiratory Medicine and Rheumatology, Institute of Health Biosciences, The University of Tokushima Graduate School
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25
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Cohen JV, Kluger HM. Systemic Immunotherapy for the Treatment of Brain Metastases. Front Oncol 2016; 6:49. [PMID: 27014624 PMCID: PMC4783384 DOI: 10.3389/fonc.2016.00049] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/19/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Justine V Cohen
- Section of Medical Oncology, Department of Medicine, Yale Cancer Center , New Haven, CT , USA
| | - Harriet M Kluger
- Section of Medical Oncology, Department of Medicine, Yale Cancer Center , New Haven, CT , USA
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26
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Guérin A, Sasane M, Dea K, Zhang J, Culver K, Nitulescu R, Wu EQ, Macalalad AR. The economic burden of brain metastasis among lung cancer patients in the United States. J Med Econ 2016; 19:526-36. [PMID: 26735844 DOI: 10.3111/13696998.2016.1138962] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Brain metastases among lung cancer patients can impair cognitive and functional ability, complicate care, and reduce survival. This study focuses on the economic burden of brain metastasis in lung cancer-direct healthcare costs to payers and indirect costs to patients, payers, and employers-in the US. METHODS Retrospective study using claims data from over 60 self-insured Fortune 500 companies across all US census regions (January 1999-March 2013). Adult, non-elderly lung cancer patients with brain metastasis were evaluated over two study periods: (1) pre-diagnosis (≤30 days prior to first observed lung cancer diagnosis to ≤30 days prior to first-observed brain metastasis diagnosis) and (2) post-diagnosis (≤30 days prior to first observed brain metastasis diagnosis to end of continuous eligibility or observation). OUTCOME MEASURES Healthcare costs to payers and resource utilization, salary loss to patients, disability payouts for payers, and productivity loss to employers. RESULTS A total of 132 patients were followed for a median of 8.4 and 6.6 months in the pre- and post-diagnosis periods, respectively. At diagnosis of brain metastasis, 21.2% of patients were on leave of absence and 6.1% on long-term disability leave. Substantial differences were observed in the pre- vs post-diagnosis periods. Specifically, patients incurred much greater healthcare utilization in the post-diagnosis period, resulting in $25,579 higher medical costs per-patient-per-6-months (PPP6M). During this period, patients missed significantly more work days, generating an incremental burden of $2853 PPP6M in salary loss for patients, $2557 PPP6M in disability payments for payers, and $4570 PPP6M in productivity loss for employers. LIMITATIONS Type of primary lung cancer and extent of brain metastasis could not be assessed in the data. The analysis was also limited to patients with comprehensive disability coverage. CONCLUSIONS Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.
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Affiliation(s)
- A Guérin
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - M Sasane
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Dea
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - J Zhang
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Culver
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - R Nitulescu
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - E Q Wu
- c c Analysis Group, Inc. , Boston , MA , USA
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27
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Bertolini F, Spallanzani A, Fontana A, Depenni R, Luppi G. Brain metastases: an overview. CNS Oncol 2015; 4:37-46. [PMID: 25586424 DOI: 10.2217/cns.14.51] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
So far brain metastases represent a critical stage of a disease course and the frequency is increasing over the years. The treatment of brain metastases should be individualized for each patient: in case of single brain metastasis, surgery or radiosurgery should be considered as first options of treatment; in case of multiple lesions, whole-brain radiotherapy is the standard of care in association with systemic therapy or surgery/radiosurgery. Chemotherapy should be considered when surgery or radiation therapy are not possible. In the last decades, TKIs or monoclonal antibodies have shown increase in overall response rate and overall survival in Phase II-III trials. The aim of this paper is to make an overview of the current approaches in management of patients with brain metastases.
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Affiliation(s)
- F Bertolini
- Department of Oncology, Azienda Ospedaliero-Universitaria Modena, via Del Pozzo, 71, 41124, Modena, Italy
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28
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Bevacizumab in Combination with Chemotherapy or Molecularly Targeted Agents for Non-Small-Cell Lung Cancer with Brain Metastases. J Thorac Oncol 2015. [PMID: 26200284 DOI: 10.1097/jto.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Zustovich F, Ferro A, Lombardi G, Farina P, Zagonel V. Bevacizumab-Based Therapy for Patients with Brain Metastases from Non-Small-Cell Lung Cancer: Preliminary Results. Chemotherapy 2015; 60:294-9. [PMID: 25999127 DOI: 10.1159/000376605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bevacizumab is a recombinant humanized monoclonal antibody that obstructs the vascular endothelial growth factor (VEGF) pathway. Despite its extensive employment in the treatment of primary tumors of the brain, experience of brain metastatic disease, a frequent complication in patients with lung cancer, is very limited. On the basis of the strong antiedemigenous effect and no risk of intracranial bleeding, we administered a bevacizumab-based chemotherapy to patients with non-small-cell lung cancer (NSCLC) and symptomatic metastatic brain lesions who were not suitable candidates for a specific local therapy. METHODS The patients received bevacizumab 7.5 mg/kg and cisplatin 75 mg/m(2) on day 1, and gemcitabine 1,250 mg/m(2) on days 1 and 8, every 21 days. RESULTS We studied 13 patients with clinical and radiological progressive brain metastases; the majority had a treatment-naïve disease. Bevacizumab-based chemotherapy was found to be well tolerated and effective: progression-free survival (PFS) was 9.1 months (range: 0.9-39.2+) and overall survival (OS) was 9.6 months (range 3-41.5+). CONCLUSIONS Bevacizumab-based therapy proved to be feasible and safe. The PFS and the OS data are very encouraging as well as the symptomatic benefit due to bevacizumab's high capacity to provide a long-lasting decrease of perilesional edema.
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30
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Schiff D, Lee EQ, Nayak L, Norden AD, Reardon DA, Wen PY. Medical management of brain tumors and the sequelae of treatment. Neuro Oncol 2015; 17:488-504. [PMID: 25358508 PMCID: PMC4483077 DOI: 10.1093/neuonc/nou304] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/28/2014] [Indexed: 12/11/2022] Open
Abstract
Patients with malignant brain tumors are prone to complications that negatively impact their quality of life and sometimes their overall survival as well. Tumors may directly provoke seizures, hypercoagulable states with resultant venous thromboembolism, and mood and cognitive disorders. Antitumor treatments and supportive therapies also produce side effects. In this review, we discuss major aspects of supportive care for patients with malignant brain tumors, with particular attention to management of seizures, venous thromboembolism, corticosteroids and their complications, chemotherapy including bevacizumab, and fatigue, mood, and cognitive dysfunction.
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Affiliation(s)
| | - Eudocia Q. Lee
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - Lakshmi Nayak
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - Andrew D. Norden
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - David A. Reardon
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - Patrick Y. Wen
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
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31
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Jiang XD, Qiao Y. Updating advances on recombinant human endostatin combined with radiotherapy for non-small cell lung cancer with brain metastasis. Transl Lung Cancer Res 2015; 1:84-8. [PMID: 25806159 DOI: 10.3978/j.issn.2218-6751.2011.12.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 12/22/2011] [Indexed: 11/14/2022]
Abstract
Brain metastases (BM) heavily affects the prognosis of advanced non-small cell lung cancer (NSCLC). Although whole-brain radiotherapy remains the mainstream therapy for BM caused by NSCLC, the effectiveness is unsatisfactory. Endostar, a recombinant human endostatin (RHES), has shown certain therapeutic effect on advanced NSCLC. This article reviews the feasibility of Endostar combined with radiotherapy in the treatment of BM caused by NSCLC.
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Affiliation(s)
- Xiao-Dong Jiang
- Department of Radiation Oncology, Lianyungang First People's Hospital, Affiliated to Xuzhou Medical College, Lianyungang, China
| | - Yun Qiao
- Department of Radiation Oncology, Lianyungang First People's Hospital, Affiliated to Xuzhou Medical College, Lianyungang, China
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Pishko GL, Muldoon LL, Pagel MA, Schwartz DL, Neuwelt EA. Vascular endothelial growth factor blockade alters magnetic resonance imaging biomarkers of vascular function and decreases barrier permeability in a rat model of lung cancer brain metastasis. Fluids Barriers CNS 2015; 12:5. [PMID: 25879723 PMCID: PMC4429592 DOI: 10.1186/2045-8118-12-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/27/2015] [Indexed: 12/27/2022] Open
Abstract
Background Blockade of vascular endothelial growth factor (VEGF) to promote vascular normalization and inhibit angiogenesis has been proposed for the treatment of brain metastases; however, vascular normalization has not been well-characterized in this disease. We investigated the effect of treatment with bevacizumab anti-VEGF antibody on magnetic resonance imaging (MRI) biomarkers of brain tumor vascular characteristics in comparison to small molecule delivery in a rat model of human lung cancer brain metastasis. Methods Athymic rats with A549 human lung adenocarcinoma intracerebral xenografts underwent MRI at 11.75 T before and one day after treatment with bevacizumab (n = 8) or saline control (n = 8) to evaluate tumor volume, free water content (edema), blood volume and vascular permeability (Ktrans). One day later, permeability to 14C-aminoisobutyric acid (AIB) was measured in tumor and brain to assess the penetration of a small drug-like molecule. Results In saline control animals, tumor volume, edema and permeability increased over the two day assessment period. Compared to controls, bevacizumab treatment slowed the rate of tumor growth (P = 0.003) and blocked the increase in edema (P = 0.033), but did not alter tumor blood volume. Bevacizumab also significantly reduced Ktrans (P = 0.033) and AIB passive permeability in tumor (P = 0.04), but not to peritumoral tissue or normal brain. Post-treatment Ktrans correlated with AIB levels in the bevacizumab-treated rats but not in the saline controls. Conclusions The correlation of an MRI biomarker for decreased vascular permeability with decreased AIB concentration in tumor after antiangiogenic treatment suggests that bevacizumab partially restored the normal low permeability characteristics of the blood–brain barrier in a model of human lung cancer brain metastasis.
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Okita Y, Nonaka M, Umehara T, Kanemura Y, Kodama Y, Mano M, Nakajima S. Efficacy of temozolomide and bevacizumab for the treatment of leptomeningeal dissemination of recurrent glioblastoma: A case report. Oncol Lett 2015; 9:1885-1888. [PMID: 25789061 PMCID: PMC4356381 DOI: 10.3892/ol.2015.2940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 01/19/2015] [Indexed: 01/09/2023] Open
Abstract
The prognosis of leptomeningeal dissemination of recurrent glioblastoma is poor, and chemotherapy results in minimal palliative efficacy. Temozolomide (TMZ) is an established therapy for patients with malignant glioma and the standard of care in parenchymal gliomas; however, few reports have been published with regard to its use for the treatment of leptomeningeal dissemination. Only one report has indicated the radiographic response of leptomeningeal dissemination to a TMZ rechallenge, suggesting a potential causative effect. While bevacizumab is an effective therapy for recurrent glioblastoma, its effect on leptomeningeal dissemination of recurrent glioblastoma remains unclear. The present study reports a case of leptomeningeal dissemination of recurrent glioblastoma in which transient neurological and radiological improvement was observed following chemotherapy with TMZ and bevacizumab. However, five months after the diagnosis of leptomeningeal dissemination the patient succumbed to the disease.
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Affiliation(s)
- Yoshiko Okita
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
| | - Masahiro Nonaka
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
| | - Toru Umehara
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan ; Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
| | - Yoshinori Kodama
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
| | - Shin Nakajima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan
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Abstract
Brain metastases are a common and devastating complication of cancer. The approach to the management of brain metastases is often multidisciplinary and includes surgery, whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and systemic therapeutic agents. Until recently, systemic therapy has had a limited role in the management of brain metastases because of a lack of activity, challenges of blood-brain barrier penetration, the heterogeneous patient population, and a heavily pretreated patient population. Advances in the understanding of the biology of brain metastases and molecularly defined disease subsets have facilitated an emerging role of novel therapeutic agents, including targeted therapies and immunotherapy, in the management of brain metastases.
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Affiliation(s)
- Manmeet S Ahluwalia
- From the Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH; Neurology Clinic, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Frank Winkler
- From the Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH; Neurology Clinic, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
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35
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Lin G, Xu H, Huang C. [Advances in treatment of brain metastases from primary non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:877-83. [PMID: 25539615 PMCID: PMC6000406 DOI: 10.3779/j.issn.1009-3419.2014.12.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
脑是非小细胞肺癌常见的转移部位,手术和放疗是以往脑转移治疗的基石,但近年来随着对肿瘤发生发展机制的认识深化,靶向治疗在脑转移治疗中开始崭露头角。本文主要针对一些相关热点问题如脑转移治疗手段等(手术、放疗、化疗、靶向治疗)进行简要述评。
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Affiliation(s)
- Gen Lin
- Department of Medical Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Teaching Hospital,
Fuzhou 350014, China
| | - Haipeng Xu
- Department of Medical Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Teaching Hospital,
Fuzhou 350014, China
| | - Cheng Huang
- Department of Medical Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Teaching Hospital,
Fuzhou 350014, China
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36
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Lévy C, Allouache D, Lacroix J, Dugué AE, Supiot S, Campone M, Mahe M, Kichou S, Leheurteur M, Hanzen C, Dieras V, Kirova Y, Campana F, Le Rhun E, Gras L, Bachelot T, Sunyach MP, Hrab I, Geffrelot J, Gunzer K, Constans JM, Grellard JM, Clarisse B, Paoletti X. REBECA: a phase I study of bevacizumab and whole-brain radiation therapy for the treatment of brain metastasis from solid tumours. Ann Oncol 2014; 25:2351-2356. [PMID: 25274615 DOI: 10.1093/annonc/mdu465] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Brain metastases (BMs) are associated with a poor prognosis. Standard treatment comprises whole-brain radiation therapy (WBRT). As neo-angiogenesis is crucial in BM growth, combining angiogenesis inhibitors such as bevacizumab with radiotherapy is of interest. We aimed to identify the optimal regimen of bevacizumab combined with WBRT for BM for phase II evaluation and provide preliminary efficacy data. PATIENTS AND METHODS In this multicentre single-arm phase I study with a 3 + 3 dose-escalation design, patients with unresectable BM from solid tumours received three cycles of bevacizumab at escalating doses [5, 10 and 15 mg/kg every 2 weeks at dose levels (DL) 0, 1 and 2, respectively] and WBRT (30 Gy/15 fractions/3 weeks) administered from day 15. DL3 consisted of bevacizumab 15 mg/kg with WBRT from day 15 in 30 Gy/10 fractions/2 weeks. Safety was evaluated using NCI-CTCAE version 3. BM response (RECIST 1.1) was assessed by magnetic resonance imaging at 6 weeks and 3 months after WBRT. RESULTS Nineteen patients were treated, of whom 13 had breast cancer. There were no DLTs. Grade 1-2 in-field and out-field toxicities occurred for five and nine patients across all DLs, respectively, including three and six patients (including one patient with both, so eight patients overall) of nine patients in DL3. One patient experienced BM progression during treatment (DL0). At the 3-month post-treatment assessment, 10 patients showed a BM response: one of three treated at DL0, one of three at DL1, two of three at DL2 and six of seven at DL3, including one complete response. BM progression occurred in five patients, resulting in two deaths. The remaining patient died from extracranial disease progression. CONCLUSION Bevacizumab combined with WBRT appears to be a tolerable treatment of BM. DL3 warrants further efficacy evaluation based on the favourable safety/efficacy balance. ClinicalTrials.gov Identifier: NCT01332929.
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Affiliation(s)
| | | | - J Lacroix
- Department of Radiology, Centre François Baclesse, Caen; Department of GIP Cyceron, Caen
| | - A E Dugué
- Department of Clinical Research, Centre François Baclesse, Caen
| | | | | | - M Mahe
- Department of Radiotherapy, Institut de Cancérologie de l'Ouest René Gauducheau, Nantes-Saint Herblain, Caen
| | - S Kichou
- Department of Radiology, Centre François Baclesse, Caen
| | | | - C Hanzen
- Department of Radiotherapy, Centre Henri Becquerel, Rouen
| | | | - Y Kirova
- Department of Radiotherapy, Institut Curie, Paris
| | - F Campana
- Department of Radiotherapy, Institut Curie, Paris
| | | | - L Gras
- Department of Radiotherapy, Centre Oscar Lambret, Lille
| | | | - M-P Sunyach
- Department of Radiotherapy, Centre Léon Bérard, Lyon
| | | | - J Geffrelot
- Department of Radiotherapy, Centre François Baclesse, Caen
| | - K Gunzer
- Department of Oncology; Department of Clinical Research, Centre François Baclesse, Caen
| | - J-M Constans
- Department of GIP Cyceron, Caen; Department of Radiology, Centre Hospitalier Universitaire, Caen
| | - J-M Grellard
- Department of Clinical Research, Centre François Baclesse, Caen
| | - B Clarisse
- Department of Clinical Research, Centre François Baclesse, Caen
| | - X Paoletti
- Department of Biostatistics, Institut Curie/Inserm U900, Paris, France
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Huillard O, Defaucheux C, Chapron J, Dusser D, Boudou-Rouquette P, Alexandre J, Goldwasser F. How should we manage bevacizumab toxicity in lung cancer patients? Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Bevacizumab is an antiangiogenic targeted therapy approved for the treatment of patients with advanced non-small-cell lung cancer other than predominantly squamous cell histology in addition to platinum-based chemotherapy. The safety of bevacizumab has been assessed in studies across most cancer types and bevacizumab is generally well tolerated. Some specific issues associated with the use of bevacizumab in lung cancer are discussed in this report (pulmonary hemorrhage, brain metastases or concurrent thoracic radiotherapy) as well as frequent and clinically relevant adverse events and their management. Oncologists and pulmonologists should be aware of such events and their management since the prescription of bevacizumab concerns many patients and the future use in maintenance therapy will be associated with prolonged treatment.
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Affiliation(s)
- Olivier Huillard
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Cécile Defaucheux
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Jeanne Chapron
- Department of Respiratory Medicine, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Daniel Dusser
- Department of Respiratory Medicine, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Pascaline Boudou-Rouquette
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - Jérôme Alexandre
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
| | - François Goldwasser
- Angiogenesis inhibitors multidisciplinary study group (CERIA), Department of Medical Oncology, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France
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Brain metastasis: new opportunities to tackle therapeutic resistance. Mol Oncol 2014; 8:1120-31. [PMID: 24953014 DOI: 10.1016/j.molonc.2014.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/15/2014] [Accepted: 05/21/2014] [Indexed: 01/14/2023] Open
Abstract
Brain metastasis is a devastating complication of cancer with unmet therapeutic needs. The incidence of brain metastasis has been rising in cancer patients and its response to treatment is limited due to the singular characteristics of brain metastasis (i.e., blood-brain-barrier, immune system, stroma). Despite improvements in the treatment and control of extracranial disease, the outcomes of patients with brain metastasis remain dismal. The mechanisms that allow tumor cells to promulgate metastases to the brain remain poorly understood. Further work is required to identify the molecular alterations inherent to brain metastasis in order to identify novel therapeutic targets and explicate the mechanisms of resistance to systemic therapeutics. In this article, we review current knowledge of the unique characteristics of brain metastasis, implications in therapeutic resistance, and the possibility of developing biomarkers to rationally guide the use of targeted agents.
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Barresi V, Branca G, Caffo M, Caltabiano R, Ieni A, Vitarelli E, Lanzafame S, Tuccari G. Immuno-expression of endoglin and smooth muscle actin in the vessels of brain metastases. Is there a rational for anti-angiogenic therapy? Int J Mol Sci 2014; 15:5663-79. [PMID: 24699047 PMCID: PMC4013588 DOI: 10.3390/ijms15045663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 12/19/2022] Open
Abstract
Despite ongoing clinical trials, the efficacy of anti-angiogenic drugs for the treatment of brain metastases (BM) is still questionable. The lower response rate to anti-angiogenic therapy in the presence of BM than in metastatic disease involving other sites suggests that BM may be insensitive to these drugs, although the biological reasons underlining this phenomenon are still to be clarified. With the aim of assessing whether the targets of anti-angiogenic therapies are actually present in BM, in the present study, we analyzed the microvessel density (MVD), a measure of neo-angiogenesis, and the vascular phenotype (mature vs. immature) in the tumor tissue of a series of BM derived from different primary tumors. By using immunohistochemistry against endoglin, a specific marker for newly formed vessels, we found that neo-angiogenesis widely varies in BM depending on the site of the primary tumor, as well as on its histotype. According to our results, BM from lung cancer displayed the highest MVD counts, while those from renal carcinoma had the lowest. Then, among BM from lung cancer, those from large cell and adenocarcinoma histotypes had significantly higher MVD counts than those originating from squamous cell carcinoma (p = 0.0043; p = 0.0063). Of note, MVD counts were inversely correlated with the maturation index of the endoglin-stained vessels, reflected by the coverage of smooth muscle actin (SMA) positive pericytes (r = −0.693; p < 0.0001). Accordingly, all the endoglin-positive vessels in BM from pulmonary squamous cell carcinoma and renal carcinoma, displayed a mature phenotype, while vessels with an immature phenotype were found in highly vascularized BM from pulmonary large cell and adenocarcinoma. The low MVD and mature phenotype observed in BM from some primary tumors may account for their low sensitivity to anti-angiogenic therapies. Although our findings need to be validated in correlative studies with a clinical response, this should be taken into account in therapeutic protocols in order to avoid the adverse effects of useless therapies.
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Affiliation(s)
- Valeria Barresi
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Giovanni Branca
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Maria Caffo
- Department of Neurosciences, University of Messina, Messina 98125, Italy.
| | - Rosario Caltabiano
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania 95123, Italy.
| | - Antonio Ieni
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Enrica Vitarelli
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Salvatore Lanzafame
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania 95123, Italy.
| | - Giovanni Tuccari
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
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Abd-El-Barr MM, Chiocca EA. Who benefits from surgery for brain metastases? World Neurosurg 2014; 82:e115-6. [PMID: 24636934 DOI: 10.1016/j.wneu.2014.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Neurosurgery, Harvard Medical School, Institute for the Neurosciences at the Brigham and Women's/Faulkner Hospital, and Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Harvard Medical School, Institute for the Neurosciences at the Brigham and Women's/Faulkner Hospital, and Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Hata A, Fujita S, Takayama K, Katakami N. Bevacizumab for critical brain metastases in a patient with pulmonary pleomorphic carcinoma. Intern Med 2014; 53:1813-8. [PMID: 25130117 DOI: 10.2169/internalmedicine.53.2007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Bevacizumab was initially contraindicated in patients with brain metastases, but several reports have shown the efficacy and safety of bevacizumab for brain metastases. We herein report the case of a patient with pulmonary pleomorphic carcinoma for which bevacizumab plus weekly paclitaxel following whole-brain radiotherapy (WBRT) was effectively and safely administered for critical and refractory brain metastases. Although the 50-year-old male patient received WBRT with anti-edema therapies for progressive brain metastases, his clinical symptoms deteriorated rapidly. After the completion of WBRT, we administered bevacizumab plus weekly paclitaxel, and his neurological symptoms improved dramatically. Brain magnetic resonance imaging demonstrated a marked response by the brain metastases and improved brain edema. This case suggested both synergism between WBRT and bevacizumab, and an anti-edema effect of bevacizumab. Bevacizumab may be therefore a potent therapeutic option for patients with refractory brain metastases.
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Affiliation(s)
- Akito Hata
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Japan
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Abstract
OPINION STATEMENT Brain metastases are a major clinical problem in patients with advanced breast cancer, lung cancer, melanoma, and renal cell carcinoma. Initial treatment for patients with brain metastases typically includes radiotherapy, either whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), or both. Surgical resection is generally reserved for good prognosis patients with limited/controlled extracranial metastases and a single brain lesion. Once patients progress through upfront treatment, the treatment approach is quite variable and there is no clearly defined standard-of-care. Over the past decade, the role of systemic therapies and in particular, targeted therapies has been increasingly explored in patients with brain metastases from solid tumors. For example, lapatinib has been studied as monotherapy, and in combination with capecitabine, in patients with HER2-positive breast cancer, and activity has been observed in both the upfront and refractory settings. In patients with nonsmall cell lung cancer (NSCLC), central nervous system (CNS) activity has been reported with gefinitib and erlotinib. Finally, in melanoma, the B-raf inhibitors vemurafenib and dabrafenib, and the immunomodulator, ipilumimab, have reported CNS activity. Moving forward, the challenge will be to understand how to optimize the activity of targeted agents in the CNS and how to best incorporate them into the current treatment paradigms in order to improve outcomes for this patient population.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA,
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Franceschi E, Bartolotti M, Poggi R, Battista MD, Palleschi D, Brandes AA. The role of systemic and targeted therapies in brain metastases. Expert Rev Anticancer Ther 2013; 14:93-103. [DOI: 10.1586/14737140.2014.856760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kim YH, Nagai H, Ozasa H, Sakamori Y, Mishima M. Therapeutic strategy for non-small-cell lung cancer patients with brain metastases (Review). Biomed Rep 2013; 1:691-696. [PMID: 24649011 DOI: 10.3892/br.2013.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/08/2013] [Indexed: 12/25/2022] Open
Abstract
Brain metastases are frequently encountered in patients with non-small-cell lung cancer (NSCLC) and are a significant cause of morbidity and mortality. Chemotherapy has been deemed ineffective under the hypothesis that the blood-brain barrier (BBB) limits the delivery of chemotherapeutic agents to the brain. Thus, radiotherapy and occasionally surgery have been selected for the treatment of brain metastases. However, recent clinical data suggested that chemotherapy may be an effective treatment option for patients with brain metastases, since patients who have developed brain metastases may have an inherently compromised BBB. The prognosis of NSCLC patients with brain metastases is generally poor and more effective treatment is required to improve their prognosis. Bevacizumab (Avastin) is a humanized monoclonal antibody that inhibits tumor angiogenesis by neutralizing the vascular endothelial growth factor. Preclinical data indicated that bevacizumab may be effective in preventing as well as treating preexisting brain metastases. Although safety concerns regarding intracranial hemorrhage have been a barrier for the use of bevacizumab in patients with brain metastases, safety data have gradually been accumulated through recent clinical trials. In this review, we aimed to summarize the currently available treatment options and present a therapeutic strategy for NSCLC patients with brain metastases, with a special emphasis on bevacizumab.
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Affiliation(s)
- Young Hak Kim
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hiroki Nagai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hiroaki Ozasa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Boothe D, Young R, Yamada Y, Prager A, Chan T, Beal K. Bevacizumab as a treatment for radiation necrosis of brain metastases post stereotactic radiosurgery. Neuro Oncol 2013; 15:1257-63. [PMID: 23814264 DOI: 10.1093/neuonc/not085] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cerebral radiation necrosis (RN) is a difficult to treat complication of stereotactic radiosurgery (SRS) that can result in progressive neurologic decline. Currently, steroids are the standard of care treatment for brain RN despite their adverse effect profile and limited efficacy. The purpose of this study was to evaluate the treatment efficacy of cerebral RN to bevacizumab in patients with brain metastases previously treated with SRS. METHODS We retrospectively reviewed 14 lesions in 11 patients treated with bevacizumab for brain RN secondary to SRS for their brain metastases. Steroid dosing, RN-associated symptoms, and magnetic resonance imaging (MRI) scans were examined before, during, and after bevacizumab administration. RESULTS Of the 11 patients included, 6 had metastatic non-small cell lung cancer, and 5 had metastatic breast cancer. The mean percentage decrease in RN volume seen on T1 post-Gadolinium and fluid-attenuated inversion recovery (FLAIR) MRI at first follow-up, at a mean of 26 days (range, 15-43 days), was 64.4% and 64.3%, respectively. MRI changes were sustained on follow-up MRI scans, obtained at a mean of 33 days (range, 7-58 days) after bevacizumab discontinuation. After bevacizumab treatment, all patients initially receiving steroids had a reduction in steroid requirement, and all but one had an improvement in or stability of RN-associated symptoms. No patients experienced intratumoral bleeds or other adverse effects related to their bevacizumab treatment. CONCLUSIONS Bevacizumab is effective and safe for the treatment of RN after SRS for brain metastasis. In this context, bevacizumab offers symptomatic relief, a reduction in steroid requirement, and a dramatic radiographic response.
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Affiliation(s)
- Dustin Boothe
- Department of Radiation Oncology, Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Rinne ML, Lee EQ, Nayak L, Norden AD, Beroukhim R, Wen PY, Reardon DA. Update on bevacizumab and other angiogenesis inhibitors for brain cancer. Expert Opin Emerg Drugs 2013; 18:137-53. [PMID: 23668489 DOI: 10.1517/14728214.2013.794784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Primary and metastatic brain tumors remain a major challenge. The most common primary adult malignant brain tumor, glioblastoma (GBM), confers a dismal prognosis as does the development of CNS metastases for most systemic malignancies. Anti-angiogenic therapy has been a major clinical research focus in neuro-oncology over the past 5 years. AREAS COVERED Culmination of this work includes US FDA accelerated approval of bevacizumab for recurrent GBM and the completion of two placebo-controlled Phase III studies of bevacizumab for newly diagnosed GBM. A multitude of anti-angiogenics are in evaluation for neuro-oncology patients but none has thus far surpassed the therapeutic benefit of bevacizumab. EXPERT OPINION These agents demonstrate adequate safety and the majority of GBM patients derive benefit. Furthermore, their anti-permeability effect can substantially decrease tumor-associated edema leading to stable or improved neurologic function and quality of life. In particular, anti-angiogenics significantly prolong progression-free survival - a noteworthy achievement in the context of infiltrative and destructive brain tumors like GBM; however, in a manner analogous to other cancers, their impact on overall survival for GBM patients is modest at best. Despite substantial clinical research efforts, many fundamental questions regarding anti-angiogenic agents in brain tumor patients remain unanswered.
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Affiliation(s)
- Mikael L Rinne
- Dana-Farber/Brigham and Women's Cancer Center, Center for Neuro-Oncology, Boston, MA, USA
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Taylor J, Gerstner ER. Anti-angiogenic therapy in high-grade glioma (treatment and toxicity). Curr Treat Options Neurol 2013; 15:328-37. [PMID: 23417315 DOI: 10.1007/s11940-013-0224-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Malignant gliomas continue to have a very poor prognosis and treatment responses at recurrence are very limited. Though anti-angiogenic therapy has not yet been shown to extend overall survival in this patient population, there is likely substantial benefit to reducing vasogenic edema, allowing for temporary improvement in neurologic function, and minimizing the side effects of prolonged corticosteroid use. A trial of bevacizumab should be considered in those with worsening vasogenic cerebral edema such as seen in recurrent malignant gliomas, radiation necrosis, or progressive brain metastases. However, not all patients respond to anti-angiogenic treatment and if no radiographic or clinical responses are seen, then patients are not likely to benefit from further infusions. Though it is commonly well tolerated, some side effects, while rare, may be life threatening, and should be discussed with patients and their families. These discussions should also outline the goals of initiating therapy and when treatment should be stopped.
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Affiliation(s)
- Jennie Taylor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Yawkey 9E, 55 Fruit Street, Boston, MA, 02114, USA
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Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. Surg Neurol Int 2013; 4:S265-88. [PMID: 23717798 PMCID: PMC3656567 DOI: 10.4103/2152-7806.111304] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/11/2013] [Indexed: 11/04/2022] Open
Abstract
Leptomeningeal metastasis (LM) results from metastatic spread of cancer to the leptomeninges, giving rise to central nervous system dysfunction. Breast cancer, lung cancer, and melanoma are the most frequent causes of LM among solid tumors in adults. An early diagnosis of LM, before fixed neurologic deficits are manifest, permits earlier and potentially more effective treatment, thus leading to a better quality of life in patients so affected. Apart from a clinical suspicion of LM, diagnosis is dependent upon demonstration of cancer in cerebrospinal fluid (CSF) or radiographic manifestations as revealed by neuraxis imaging. Potentially of use, though not commonly employed, today are use of biomarkers and protein profiling in the CSF. Symptomatic treatment is directed at pain including headache, nausea, and vomiting, whereas more specific LM-directed therapies include intra-CSF chemotherapy, systemic chemotherapy, and site-specific radiotherapy. A special emphasis in the review discusses novel agents including targeted therapies, that may be promising in the future management of LM. These new therapies include anti-epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors erlotinib and gefitinib in nonsmall cell lung cancer, anti-HER2 monoclonal antibody trastuzumab in breast cancer, anti-CTLA4 ipilimumab and anti-BRAF tyrosine kinase inhibitors such as vermurafenib in melanoma, and the antivascular endothelial growth factor monoclonal antibody bevacizumab are currently under investigation in patients with LM. Challenges of managing patients with LM are manifold and include determining the appropriate patients for treatment as well as the optimal route of administration of intra-CSF drug therapy.
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Affiliation(s)
- Emilie Le Rhun
- Breast Unit, Department of Medical Oncology, Centre Oscar Lambret and Department of Neuro Oncology, Roger Salengro Hospital, University Hospital, Lille, France
| | - Sophie Taillibert
- Neurology, Mazarin and Radiation Oncology, Pitié Salpétrière Hospital, University Pierre et Marie Curie, Paris VI, Paris, France
| | - Marc C. Chamberlain
- Neurology and Neurological Surgery, University of Washington, Fred Hutchinson Research Cancer Center, Seattle, WA, USA
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Narita Y. Drug review: Safety and efficacy of bevacizumab for glioblastoma and other brain tumors. Jpn J Clin Oncol 2013; 43:587-95. [PMID: 23585688 DOI: 10.1093/jjco/hyt051] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Glioblastoma is a highly vascular tumor that expresses vascular endothelial growth factor, a key regulator of angiogenesis and tumor blood vessel permeability. Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor and the growth of gliomas. Bevacizumab monotherapy has proven effective for recurrent glioblastoma, and it extended progression-free survival and improved patient quality of life in various clinical trials. Some patients who receive bevacizumab experience improvements in neurological symptoms and steroid dose reductions. Bevacizumab induces a dramatic and rapid radiological response, but non-enhancing lesions are often detected on magnetic resonance imaging without enhancing lesions. Rebound phenomena such as rapid tumor regrowth are occasionally observed after the discontinuation of bevacizumab therapy. Therefore, Response Assessment in Neuro-Oncology criteria were recently devised to evaluate the efficacy and radiological response of bevacizumab treatment. Hypertension and proteinuria are characteristic adverse events associated with bevacizumab therapy. In addition, many fatal adverse events such as intracranial hemorrhage and venous thromboembolism are reported in patients treated with bevacizumab. However, these events are also associated with glioma itself, and careful attention needs to be paid to these events. Bevacizumab is used to treat various diseases including radiation necrosis and recurrent brain tumors such as brain metastases, schwannoma and meningioma, but additional clinical trials are necessary. The efficacy and current problems associated with bevacizumab in the treatment of glioblastoma and other brain tumors are reviewed.
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Affiliation(s)
- Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Addeo R, Zappavigna S, Luce A, Facchini S, Caraglia M. Chemotherapy in the management of brain metastases: the emerging role of fotemustine for patients with melanoma and NSCLC. Expert Opin Drug Saf 2013; 12:729-40. [PMID: 23560594 DOI: 10.1517/14740338.2013.789017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION An estimated 20 - 40% of cancer patients will develop brain metastases that are the most common intracranial tumors in adults. Patients with cerebral metastases represent a variegate group where selection of the most appropriate treatment depends on many patient- and disease-related factors. The impact of therapeutic option on overall survival is lacking and it is important to consider quality of life (QOL) when treating patients with brain metastases. AREAS COVERED A considerable proportion of patients are treated with palliative approaches such as whole-brain radiotherapy. The role of chemotherapy was limited in the past. Recently, several chemotherapeutic agents have been identified as potentially useful. This article examines the pharmacokinetics, efficacy and safety and tolerability of fotemustine (FTM) for the management of patients with cerebral metastasis from melanoma and non-small cell lung cancer (NSCLC). EXPERT OPINION FTM is a third-generation nitrosourea that has proved its efficacy on brain metastases of melanoma and showed promising results for the treatment of brain metastasis of NSCLC because of its ability to pass the blood-brain barrier.
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Affiliation(s)
- Raffaele Addeo
- "S. Giovanni di Dio" Hospital, ASL Napoli 2Nord, Oncology Unit, Frattamaggiore, Italy
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