Bevacizumab for Patients with Recurrent Gliomas Presenting with a Gliomatosis Cerebri Growth Pattern.
Bevacizumab for Patients with Recurrent Gliomas Presenting with a Gliomatosis Cerebri Growth Pattern.
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DOI：
10.3390/ijms18040726
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发表时间：
2017-03-29
影响因子：
5.6
通讯作者：
Bähr O
中科院分区：
文献类型：
--
作者：
Burger MC;Mildenberger IC;Wagner M;Mittelbronn M;Steinbach JP;Bähr O
贝伐单抗已被证明可以改善无进展生存期和神经功能，但未能改善新诊断胶质母细胞瘤和首次复发的总生存期。尽管如此，贝伐单抗广泛用于复发性胶质瘤患者。然而，它在显示脑胶质瘤病生长模式的神经胶质瘤患者中的使用是有争议的。由于显著的弥漫性和浸润性生长，血管生成性肿瘤生长较少，贝伐珠单抗是否能在这些患者中具有治疗效果可能存在疑问。然而，在具有脑胶质瘤生长模式的患者中，结节性、坏死性和/或对比增强病变的发展并不罕见，并且可能表明局灶性新血管生成。因此，控制这些病变的生长以及控制水肿和减少类固醇的使用可被视为在这些患者中使用贝伐珠单抗的依据。在这个回顾性的患者系列中，我们报告了17例原发性脑肿瘤患者，显示出大脑胶质瘤病的生长模式（包括7例胶质母细胞瘤，2例间变性星形细胞瘤，1例间变性少突胶质细胞瘤和7例弥漫性星形细胞瘤）。患者已接受贝伐珠单抗单药治疗或与洛莫司汀或伊立替康联合治疗。17名匹配的接受贝伐单抗治疗的具有经典生长模式的胶质瘤患者作为对照组。两组的缓解率、无进展生存期和总生存期相似。基于这些结果，贝伐单抗血管生成治疗也应该考虑在患有主要浸润性表型的胶质瘤的患者中。
Bevacizumab has been shown to improve progression-free survival and neurologic function, but failed to improve overall survival in newly diagnosed glioblastoma and at first recurrence. Nonetheless, bevacizumab is widely used in patients with recurrent glioma. However, its use in patients with gliomas showing a gliomatosis cerebri growth pattern is contentious. Due to the marked diffuse and infiltrative growth with less angiogenic tumor growth, it may appear questionable whether bevacizumab can have a therapeutic effect in those patients. However, the development of nodular, necrotic, and/or contrast-enhancing lesions in patients with a gliomatosis cerebri growth pattern is not uncommon and may indicate focal neo-angiogenesis. Therefore, control of growth of these lesions as well as control of edema and reduction of steroid use may be regarded as rationales for the use of bevacizumab in these patients. In this retrospective patient series, we report on 17 patients with primary brain tumors displaying a gliomatosis cerebri growth pattern (including seven glioblastomas, two anaplastic astrocytomas, one anaplastic oligodendroglioma, and seven diffuse astrocytomas). Patients have been treated with bevacizumab alone or in combination with lomustine or irinotecan. Seventeen matched patients treated with bevacizumab for gliomas with a classical growth pattern served as a control cohort. Response rate, progression-free survival, and overall survival were similar in both groups. Based on these results, anti-angiogenic therapy with bevacizumab should also be considered in patients suffering from gliomas with a mainly infiltrative phenotype.