Bevacizumab and irinotecan in children with recurrent or refractory brain tumors: Toxicity and efficacy trends

Abstract

Bevacizumab-related acute toxicity appears to be low in children, even in combination with irinotecan. Further prospective trials are required to confirm the hypothetical efficacy of bevacizumab and to assess the risk of long-term toxicity especially in the youngest children.

Phase I Study of Bevacizumab Plus Irinotecan in Pediatric Patients with Recurrent/Refractory Solid Tumors

“…In particular, one of the two patients with optic glioma achieved a radiographic partial response, and the other had stable disease with slight tumor shrinkage: this result seems to be encouraging and is consistent with prior retrospective studies, in which the same regimen was effective in patients with recurrent lowgrade glioma (24,26). BVZ has been reported to show antitumor activity in children who had previously been heavily treated with various cytotoxic chemotherapies (27).…”

Glioblastoma survival in the United States improved after Food and Drug Administration approval of bevacizumab: A population‐based analysis

“…To date, no large placebo-controlled trials of bevacizumab for recurrent glioblastoma have been performed, leaving open the question of to what extent bevacizumab therapy prolongs survival. Instead, recent clinical trials have focused on the efficacy of bevacizumab as part of up-front therapy for newly diagnosed glioblastoma, 4,5 in combination with other treatments in recurrent glioblastoma, [6][7][8][9][10] and in patient populations such as children, 11 or adults with World Health Organization grade III glioma. 12 However, the initial optimism regarding bevacizumab in treatment of glioblastoma has been tempered by concerns that radiographic response to treatment may in some cases simply be "pseudoresponse," a decrease in contrast-enhancement without a decrease of tumor activity as the tumor assumes a more invasive phenotype.…”

Treatment of children with high grade glioma with nimotuzumab: A 5-y institutional experience

“…In general, toxicities reported for bevacizumab were grade 1-2 hypertension, proteinuria, lymphopenia, wound healing delay, grade 1 to 3 fatigue, grade 1 central nervous system (CNS) hemorrhage and grade 4 CNS ischemia. [28][29][30][31] In summary, the feasibility and safety of prolonged administration of nimotuzumab in a pediatric population has been demonstrated, and preliminary evidences of clinical benefit in 23 HGG patients with very poor prognosis was observed. New trials in the same indication evaluating different combination schemes together with biomarker correlatives studies with nimotuzumab are warranted.…”

“…26,27 Other monoclonal antibodies such as bevacizumab, an anti-VEGF molecule, have been used in the treatment of children with brain tumors at significantly lower cumulative doses. [28][29][30][31] Children were administered bevacizumab at 10 or 15 mg/kg every 2 or 3 weeks as long as they did not show unacceptable toxicity or disease progression. In general, toxicities reported for bevacizumab were grade 1-2 hypertension, proteinuria, lymphopenia, wound healing delay, grade 1 to 3 fatigue, grade 1 central nervous system (CNS) hemorrhage and grade 4 CNS ischemia.…”