Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib
Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib
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DOI：
10.1371/journal.pone.0217340
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发表时间：
2019-06-20
期刊：
影响因子：
3.7
通讯作者：
Arrieta, Oscar
中科院分区：
文献类型：
--
作者：
Cardona, Andres F.;Ruiz-Patino, Alejandro;Arrieta, Oscar
目的比较奥曲肽/依维莫司与舒尼替尼系统治疗复发性侵袭性脑膜瘤的疗效。纳入接受全身治疗（舒尼替尼、依维莫司/奥曲肽）和完整随访的患者。评价总生存期（OS）、无进展生存期（PFS）和毒副反应。此外，组织样本进行了检查PDGFR β和VEGFR2，其表达与outcomes.ResultsTwenty-two患者（72%）是女性，中位年龄为55岁（SD +/-15.3）。最常见的组织学为间变性脑膜瘤，20例患者（65%），48%的患者在开始全身治疗前有3次复发。共有14例患者接受奥曲肽/依维莫司联合治疗，11例接受舒尼替尼治疗，其余6例接受其他二线药物治疗。中位OS为37.3个月（95% CI 28.5 - 42.1），依维莫司/奥曲肽（EO）和舒尼替尼（Su）治疗期间的PFS分别为12.1个月（95% CI 9.2 - 21.1）和9.1个月（95% CI 6.8 - 16.8）; p = 0.43）。EO-> Su-> Bev序列治疗组（一线/二线/三线）的OS比Su-> EO-> Bev序列（36.0 vs. 29.5个月）长6.5个月（p = 0.0001）。分析分子标志物时，阳性PDGFR β和阴性VEGFR2表达与OS和PFS的生存期延长相关。结论舒尼替尼和奥曲肽/依维莫司在难治性脑膜瘤的系统管理中具有相似的疗效和安全性。VEGFR2和PDGFR β表达与更好的结局相关。
PurposeTo compare the effectiveness of octreotide/everolimus vs. sunitinib for the systemic treatment of recurrent aggressive meningiomas.Methods31 patients with recurrent or refractory WHO II or WHO III meningiomas were examined in two reference centers in Colombia. Patients who had systemic treatment (sunitinib, everolimus/octreotide) and a complete follow-up were included. Overall survival (OS), progression-free survival (PFS) and toxicities were evaluated. Additionally, tissue samples were examined for PDGFR beta and VEGFR2, their expression was correlated with outcomes.ResultsTwenty-two patients (72%) were female with a median age of 55 years (SD +/- 15.3). The most prevalent histology was anaplastic meningioma in 20 patients (65%) with 48% of patients suffering from three previous relapses before the start of systemic treatment. A total of 14 patients received combination therapy with octreotide/everolimus, 11 received sunitinib and the remaining 6 received other second-line agents. Median OS was 37.3 months (95% CI 28.5-42.1) and the PFS during the treatment with everolimus/octreotide (EO) and sunitinib (Su) was 12.1 months (95% CI 9.2-21.1) and 9.1 months (95% CI 6.8-16.8); p = 0.43), respectively. The OS of the group treated with the EO -> Su -> Bev sequence (1st/2nd/3rd line) was 6.5 months longer than the Su -> EO -> Bev sequence (36.0 vs. 29.5 months) (p = 0.0001). When analyzing molecular markers, the positive PDGFR beta and negative VEGFR2 expression were associated with longer survival both in OS and PFS.ConclusionSunitinib and octreotide/everolimus have similar efficacy and safety in the systemic management of refractory meningioma. VEGFR2 and PDGFR beta expression are associated with better outcomes.