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Green K, Panagopoulou P, D’Arco F, O'Hare P, Bowman R, Walters B, Dahl C, Jorgensen M, Patel P, Slater O, Ahmed R, Bailey S, Carceller F, Collins R, Corley E, English M, Hayden J, Howells L, Kamal A, Kilday JP, Lowis S, Lumb B, Micic T, Mitra D, Pace E, Picton S, Pizer B, Shafiq A, Uzunova L, Wilson S, Wayman H, Hargrave D, Opocher E. LGG-09. A Nationwide Service Evaluation of Safety, Radiologic and Visual Outcome Refining Bevacizumab-based Treatments in Children with Progressive Low-Grade Glioma. Neuro Oncol 2022. [PMCID: PMC9164923 DOI: 10.1093/neuonc/noac079.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION: Bevacizumab/Irinotecan is currently 3rd-line treatment in the UK for progressive Paediatric Low-Grade Glioma (PLGG) based on limited evidence. A nationwide service evaluation was conducted to review its safety and efficacy amongst a larger cohort.
METHODS: Data from children with PLGG receiving Bevacizumab-based Treatments (BBT) from 11 UK Centres (2009-2020) were reviewed. Radiological and visual outcomes were based on standardized measurements. Clinical-radiological correlation was investigated. Time to progression from BBT stop, progression free-survival (PFS) curves and multivariate analysis of prognostic factors (p 0.05) were performed.
RESULTS: 88 children with PLGG (88% OPG, 24% NF1) had BBT for radiological (43%), visual (20%) or combined (27%) progression, after 40 months (median) from diagnosis. Amongst OPG cases, visual acuity (VA) per eye (better/worse) before BBT was logMAR 0.0-0.3 (23/7) 0.3 - 1.0 (27/20), > 1.0 (14/18) and LP/NLP (8/27), with 19/8 children respectively blind (LP/NLP) in one or both eyes. Bevacizumab 10 mg/kg every 14 days (median 24 doses) was given as 3rd line+ with Irinotecan (85%) or alongside 1st/2nd line chemo (15%) leading to remarkable radiological (88%) and visual (74%) responses (stable or improved) within 3-6 months, with limited toxicity. 12% progressed on treatment, and 8% died unrelated to BBT. After initial response 65% progressed at a median of 8 months (4 - 23) after BBT, resulting in 3-year-all-causes-PFS of 16% and 3-yr-visual-PFS of 45% from start of BBT. Visual concordance with MRI was poor (36%) but increases (47%) when better-eye determines visual outcome. Lack of NF1 and diencephalic syndrome (DS) at presentation were independent negative prognostic factors for PFS.
CONCLUSIONS: A remarkable but transient effect of BBT has been confirmed. Visual > radiological responses can be sustained after BBT. Variations in current BBT strategies justifies further research, including the potential upfront use alongside conventional first-line chemotherapy as sight-saving strategy.
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Affiliation(s)
| | - Paraskevi Panagopoulou
- Great Ormond Street Hospital , London , United Kingdom
- Aristotle University of Thessaloniki Medical School , Thessaloniki , Greece
| | | | - Patricia O'Hare
- Children's Hospital Belfast , Belfast , United Kingdom
- Great Ormond Street Hospital , London , United Kingdom
| | | | | | | | | | - Pritesh Patel
- Great Ormond Street Hospital , London , United Kingdom
| | - Olga Slater
- Great Ormond Street Hospital , London , United Kingdom
| | - Rehana Ahmed
- Nottingham Children's Hospital , Nottingham , United Kingdom
| | - Simon Bailey
- Great North Children's Hospital , Newcastle , United Kingdom
| | | | | | | | - Martin English
- Birmingham Children's Hospital , Birmingham , United Kingdom
| | - James Hayden
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Lisa Howells
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Ahmed Kamal
- Birmingham Children's Hospital , Birmingham , United Kingdom
| | - John Paul Kilday
- Royal Manchester Children's Hospital , Manchester , United Kingdom
| | - Stephen Lowis
- Bristol Children's Hospital , Bristol , United Kingdom
| | - Blanche Lumb
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Thomas Micic
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Dip Mitra
- Great North Children's Hospital , Newcastle , United Kingdom
| | - Erika Pace
- Royal Marsden Hospital , London , United Kingdom
| | - Susan Picton
- Leeds Children's Hospital , Leeds , United Kingdom
| | - Barry Pizer
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Ayad Shafiq
- Great North Children's Hospit , Newcastle , United Kingdom
| | - Lena Uzunova
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Shaun Wilson
- John Radcliffe Hospital , Oxford , United Kingdom
| | - Harriet Wayman
- Royal Manchester Children's Hospital , Manchester , United Kingdom
| | | | - Enrico Opocher
- Great Ormond Street Hospital , London , United Kingdom
- Padua University Hospital , Padua , Italy
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