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Tanaka T, Tamura R, Takei J, Morimoto Y, Teshigawara A, Yamamoto Y, Imai R, Kuranari Y, Tohmoto K, Hasegawa Y, Akasaki Y, Murayama Y, Miyake K, Sasaki H. An exploratory prospective phase II study of preoperative neoadjuvant bevacizumab and temozolomide for newly diagnosed glioblastoma. J Neurooncol 2024; 166:557-567. [PMID: 38291182 PMCID: PMC10876816 DOI: 10.1007/s11060-023-04544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE This multi-institutional phase I/II study was conducted to confirm the safety and explore the clinical utility of preoperative Bevacizumab (Bev) for newly diagnosed glioblastoma (GB). METHODS Patients were enrolled based on magnetic resonance imaging (MRI) findings typically suggestive of GB. Preoperative Bev and temozolomide (TMZ) were administered at doses of 10 mg/kg on day 0 and 150 mg/m2 on days 1-5, respectively. Surgical resection was performed between days 21 and 30, inclusive. The safety and efficacy were evaluated in a total of 15 cases by progression-free survival (PFS), changes in tumor volume, Karnofsky Performance Scale (KPS) and Mini-Mental State Examination (MMSE) scores after preoperative therapy. RESULTS Tumor resection was performed on a mean of day 23.7. Pathological diagnosis was GB, isocitrate dehydrogenase (IDH)-wildtype in 14 cases and GB, IDH-mutant in 1 case. Severe adverse events possibly related to preoperative Bev and TMZ were observed in 2 of the 15 patients, as wound infection and postoperative hematoma and thrombocytopenia. KPS and MMSE scores were significantly improved with preoperative therapy. Tumor volume was decreased in all but one case on T1-weighted imaging with contrast-enhancement (T1CE) and in all cases on fluid-attenuated inversion recovery, with mean volume decrease rates of 36.2% and 54.0%, respectively. Median PFS and overall survival were 9.5 months and 16.5 months, respectively. CONCLUSION Preoperative Bev and TMZ is safe as long as the instructions are followed. The strategy might be useful for GB in some patients, not only reducing tumor burden, but also improving patient KPS preoperatively. TRIAL REGISTRATION NUMBER UMIN000025579, jRCT1031180233 https://jrct.niph.go.jp/latest-detail/jRCT1031180233 . Registration Date: Jan. 16, 2017.
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Affiliation(s)
- Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa-shi Hospital, 163-1 Kashiwa-shi, Kashiwa, Chiba, 277-8567, Japan.
- Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shijuku-ku, Tokyo, 160-8582, Japan
| | - Jun Takei
- Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yukina Morimoto
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shijuku-ku, Tokyo, 160-8582, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa-shi Hospital, 163-1 Kashiwa-shi, Kashiwa, Chiba, 277-8567, Japan
| | - Yohei Yamamoto
- Department of Neurosurgery, Jikei University School of Medicine Daisan Hospital, 4-11-1 Izumi-honcho, Komae-shi, Tokyo, 201-8601, Japan
| | - Ryotaro Imai
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shijuku-ku, Tokyo, 160-8582, Japan
| | - Yuki Kuranari
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shijuku-ku, Tokyo, 160-8582, Japan
| | - Kyoichi Tohmoto
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa-shi Hospital, 163-1 Kashiwa-shi, Kashiwa, Chiba, 277-8567, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa-shi Hospital, 163-1 Kashiwa-shi, Kashiwa, Chiba, 277-8567, Japan
| | - Yasuharu Akasaki
- Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keisuke Miyake
- Department of Neurosurgery, Kagawa University Graduate School of Medicine, 1750-1 Ikedo, Miki-cho, Kida-gun, Kagawa, 761-0793, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shijuku-ku, Tokyo, 160-8582, Japan.
- Department of Neurosurgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan.
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Chen HH, Lin JK, Chen JB, Chuang CH, Liu MC, Wang JY, Changchien CR. Neoadjuvant therapy of bevacizumab in combination with oxaliplatin and capecitabine (XELOX) for patients with metastatic colorectal cancer with unresectable liver metastases: a phase II, open-label, single-arm, noncomparative trial. Asia Pac J Clin Oncol 2017; 14:61-68. [DOI: 10.1111/ajco.12692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/30/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Jen-Kou Lin
- Taipei Veterans General Hospital; Taipei Taiwan
| | - Joe-Bin Chen
- Taichung Veterans General Hospital; Taichung Taiwan
| | | | - Mei-Ching Liu
- Koo Foundation Sun Yat-Sen Cancer Center; Taipei Taiwan
| | - Jen-Yi Wang
- Chang Gung Memorial Hospital; Chai-Yi Taiwan
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Duwe G, Knitter S, Pesthy S, Beierle AS, Bahra M, Schmelzle M, Schmuck RB, Lohneis P, Raschzok N, Öllinger R, Sinn M, Struecker B, Sauer IM, Pratschke J, Andreou A. Hepatotoxicity following systemic therapy for colorectal liver metastases and the impact of chemotherapy-associated liver injury on outcomes after curative liver resection. Eur J Surg Oncol 2017; 43:1668-1681. [PMID: 28599872 DOI: 10.1016/j.ejso.2017.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 02/08/2023] Open
Abstract
Patients with colorectal liver metastases (CLM) have remarkably benefited from the advances in medical multimodal treatment and surgical techniques over the last two decades leading to significant improvements in long-term survival. More patients are currently undergoing liver resection following neoadjuvant chemotherapy, which has been increasingly established within the framework of curative-indented treatment strategies. However, the use of several cytotoxic agents has been linked to specific liver injuries that not only impair the ability of liver tissue to regenerate but also decrease long-term survival. One of the most common agents included in modern chemotherapy regimens is oxaliplatin, which is considered to induce a parenchymal damage of the liver primarily involving the sinusoids defined as sinusoidal obstruction syndrome (SOS). Administration of bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF), has been reported to improve response of CLM to chemotherapy in clinical studies, concomitantly protecting the liver from the development of SOS. In this review, we aim to summarize current data on multimodal treatment concepts for CLM, give an in-depth overview of liver damage caused by cytostatic agents focusing on oxaliplatin-induced SOS, and evaluate the role of bevacizumab to improve clinical outcomes of patients with CLM and to protect the liver from the development of SOS.
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Affiliation(s)
- G Duwe
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - S Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - S Pesthy
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - A S Beierle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - M Bahra
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - M Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - R B Schmuck
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - P Lohneis
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Germany
| | - N Raschzok
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - R Öllinger
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - M Sinn
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Germany
| | - B Struecker
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - I M Sauer
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - J Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany
| | - A Andreou
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Germany; Berlin School of Integrative Oncology, Charité - Universitätsmedizin Berlin, Germany.
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Konda B, Shum H, Rajdev L. Anti-angiogenic agents in metastatic colorectal cancer. World J Gastrointest Oncol 2015; 7:71-86. [PMID: 26191351 PMCID: PMC4501927 DOI: 10.4251/wjgo.v7.i7.71] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/13/2015] [Accepted: 06/01/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is a major public health concern being the third leading cause of cancer mortality in the United States. The availability of better therapeutic options has led to a decline in cancer mortality in these patients. Surgical resection should be considered in all stages of the disease. The use of conversion therapy has made surgery a potentially curative option even in patients with initially unresectable metastatic disease. In this review we discuss the role of various anti-angiogenic agents in patients with metastatic CRC (mCRC). We describe the mechanism of action of these agents, and the rationale for their use in combination with chemotherapy. We also review important clinical studies that have evaluated the safety and efficacy of these agents in mCRC patients. Despite the discovery of several promising anti-angiogenic agents, mCRC remains an incurable disease with a median overall survival of just over 2 years in patients exposed to all available treatment regimens. Further insights into tumor biology and tumor microenvironment may help improve outcomes in these patients.
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Giakoustidis A, Neofytou K, Khan A, Mudan S. Addition of bevacizumab to preoperative chemotherapy for colorectal liver metastases does not increase perioperative morbidity and mortality. Hepat Oncol 2014; 1:363-375. [PMID: 30190972 PMCID: PMC6095412 DOI: 10.2217/hep.14.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Patients with colorectal liver metastases (CRLM) benefit from liver resection. Bevacizumab is commonly used in these patients resulting in a greater number of patients receiving an operation for a potentially curative liver resection, with initially unresectable liver metastases. Our purpose was to evaluate the effect of preoperative bevacizumab administration on perioperative complications in patients undergoing hepatic resection for CRLM. METHODS A retrospective analysis of patients undergoing hepatic resection for CRLM who received only neoadjuvant chemotherapy (chemotherapy group, n = 133), or neoadjuvant chemotherapy and bevacizumab (chemotherapy and bevacizumab group, n = 103). We compared surgical characteristics, perioperative complications and postoperative liver function. RESULTS The type of liver resection (minor vs major liver resection) was comparable in the two groups (major liver resection 52.6 vs 62.1%, p = 0.144). The addition of bevacizumab to preoperative chemotherapy does not affect the frequency (chemotherapy group vs chemotherapy and bevacizumab group, 35.3 vs 38.8%, p = 0.581), severity (major complications, 20.3 vs 19.4%, p = 0.487) and type of perioperative complications. Preoperative administration of bevacizumab was associated with a higher peak of postoperative alanine aminotransferase levels but did not affect functional recovery of the liver. CONCLUSION Neoadjuvant administration of bevacizumab was not associated with an increased risk of postoperative complications after hepatic resection and did not affect the liver's functional recovery. Patients receiving more than eight cycles of bevacizumab are at an increased risk to develop perioperative complications.
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Affiliation(s)
| | - Kyriakos Neofytou
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Aamir Khan
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Satvinder Mudan
- Department of Surgery, The London Clinic, 116 Harley Street, London, W1G 7JL, UK
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
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Dede K, Salamon F, Landherr L, Jakab F, Bursics A. Pathologic assessment of response to chemotherapy in colorectal cancer liver metastases after hepatic resection: which method to use? Pathol Oncol Res 2014; 21:173-9. [PMID: 24898285 DOI: 10.1007/s12253-014-9803-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 05/22/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with metastatic colorectal cancer receive chemotherapy prior liver resection more and more frequently. Histopathologic assessment methods of the resected specimen could evaluate the response to chemotherapy. In this study it is analyzed if these histopathologic changes are specific to preoperative chemotherapy and if these methods have correlation with survival. METHODS Sixty three patients with available pathology slides, resected for colorectal cancer liver metastases were enrolled in this study. 46 patients (73%) received neoadjuvant chemotherapy. Five pathological evaluation methods were compared according to the literature: [1] residual tumor cell ratio, [2] tumor regression grade (TRG) scoring system, [3] modified tumor regression grade (mTRG) scoring system with the type of necrosis, [4] pattern of tumor regression and [5] the tumor thickness at the tumor-normal interface (TNI). RESULTS Analyzing the pathological methods between the chemotherapy (CTX) and the non-chemotherapy group (NC), we found that that four evaluation methods showed significant and one showed strong correlation with the use of chemotherapy. (Residual tumor cell ratio: p = 0.08; TRG: p <0.01; mTRG: p = 0.03; pattern of tumor regression: p <0.01; TNI: p = 0.02). In the chemotherapy group none of the analyzed pathological methods showed significant correlation with progression free survival (PFS) or with overall survival (OS). Residual tumor cell ratio, TRG and the pattern of tumor cells showed positive but not significant correlation with OS and PFS and a slight difference in the group of patients with TNI <2 mm could be documented. CONCLUSIONS Tumor regression grade (TRG) and tumor thickness at the tumor-normal interface (TNI) were the most useful methods for pathological response evaluation and these methods had some correlation with survival. According to these data, authors concluded, that a reproducible and well defined scoring system, based on different histopathological evaluation methods should be developed to predict more accurately the effect of neoadjuvant chemotherapy in CRCLM patients.
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Affiliation(s)
- K Dede
- Department of Surgery-Oncological Surgery, Uzsoki Teaching Hospital, 1145, Budapest, Uzsoki utca 29, Hungary,
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Dede K, Láng I, Pörneczi B, Mester G, Fekete A, Kőszegi G, Mersich T, Besznyák I, Bursics A. [Preoperative chemotherapy in the surgical treatment of colorectal liver metastases]. Magy Seb 2014; 66:325-30. [PMID: 24333977 DOI: 10.1556/maseb.66.2013.6.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The only curative treatment of colorectal liver metastases (CRLM) is surgical resection. Preoperative/neoadjuvant chemotherapy can be used for resectable, for borderline resectable or even for irresectable CRLM patients. PATIENTS Data of CRLM patients treated with surgical resection at the Uzsoki Hospital were analysed. Patients were classified into two groups, (A) who received preoperative chemotherapy before hepatic resection, and (B) who received no chemotherapy before resection. RESULTS Between 01.01.2007. and 31.12.2010. 128 CRLM patients were treated with hepatic resection. 68 patients (53%) received chemotherapy before hepatic resection, 60 patients (47%) were resected without neoadjuvant chemotherapy. There was no significant difference in the complications between the groups (p = 0.39). Median overall survival was 41 months. The progression free survival (PFS) at 3 and 5 years were 25%, the 3 and 5 year overall survival (OS) were 55% and 31%. Both PFS and OS were significantly worse in the chemotherapy group (p = 0.014, p = 0.015). The subgroup of patients receiving bevacizumab containing preoperative chemotherapy has significanly better PFS than patients receiving only cytotoxic chemotherapy (p = 0.004). CONCLUSION Surgical resection of CRLM patients results good survival data even in non-selected patients, although the very long survival results reported in the literature couldn't have been reproduced in this patient population. When preoperative chemotherapy was combined with bevacizumab, survival was similar to the upfront resected patients.
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Affiliation(s)
- Kristóf Dede
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - István Láng
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Balázs Pörneczi
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Gábor Mester
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - András Fekete
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - György Kőszegi
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Tamás Mersich
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - István Besznyák
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
| | - Attila Bursics
- Uzsoki Utcai Kórház Sebészeti Osztály 1145 Budapest Uzsoki u. 29
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Effect of Tyrosine Kinase Inhibitors on Wound Healing and Tissue Repair: Implications for Surgery in Cancer Patients. Drug Saf 2014; 37:135-49. [DOI: 10.1007/s40264-014-0139-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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