Corticosteroid Use in Patients with Glioblastoma at First or Second Relapse Treated with Bevacizumab in the BRAIN Study

Vredenburgh, James J.; Cloughesy, Timothy F.; Samant, Meghna; Prados, Michael D.; Wen, Patrick Y.; Mikkelsen, Tom; Schiff, David; Abrey, Lauren E.; Yung, W. K. Alfred; Paleologos, Nina A.; Nicholas, M. Kelly; Jensen, Randy L.; Das, Asha; Friedman, Henry S.

doi:10.1634/theoncologist.2010-0105

Cited by 97 publications

(64 citation statements)

References 14 publications

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“…Approximately 30 -70% of patients who received bevacizumab could reduce their steroid doses (14,33). Steroids have been used to treat patients with brain tumors to control brain edema, and bevacizumab is occasionally considered an 'expensive super steroid'.…”

Section: Recurrent Gbmmentioning

confidence: 99%

Drug Review: Safety and Efficacy of Bevacizumab for Glioblastoma and Other Brain Tumors

Narita¹

2013

Japanese Journal of Clinical Oncology

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Glioblastoma is a highly vascular tumor that expresses vascular endothelial growth factor, a key regulator of angiogenesis and tumor blood vessel permeability. Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor and the growth of gliomas. Bevacizumab monotherapy has proven effective for recurrent glioblastoma, and it extended progression-free survival and improved patient quality of life in various clinical trials. Some patients who receive bevacizumab experience improvements in neurological symptoms and steroid dose reductions. Bevacizumab induces a dramatic and rapid radiological response, but non-enhancing lesions are often detected on magnetic resonance imaging without enhancing lesions. Rebound phenomena such as rapid tumor regrowth are occasionally observed after the discontinuation of bevacizumab therapy. Therefore, Response Assessment in Neuro-Oncology criteria were recently devised to evaluate the efficacy and radiological response of bevacizumab treatment. Hypertension and proteinuria are characteristic adverse events associated with bevacizumab therapy. In addition, many fatal adverse events such as intracranial hemorrhage and venous thromboembolism are reported in patients treated with bevacizumab. However, these events are also associated with glioma itself, and careful attention needs to be paid to these events. Bevacizumab is used to treat various diseases including radiation necrosis and recurrent brain tumors such as brain metastases, schwannoma and meningioma, but additional clinical trials are necessary. The efficacy and current problems associated with bevacizumab in the treatment of glioblastoma and other brain tumors are reviewed.

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Section: Recurrent Gbmmentioning

confidence: 99%

Drug Review: Safety and Efficacy of Bevacizumab for Glioblastoma and Other Brain Tumors

Narita¹

2013

Japanese Journal of Clinical Oncology

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“…Despite concerns regarding the lack of durable responses and the failure to demonstrate of an overall survival (OS) benefit, the use of BEV in recurrent glioma has widely spread to other glioma entities. This may be due to beneficial effects of BEV on performance status and steroid use [6] and the apparent lack of alternative options after the failure of alkylating agent therapy.…”

Section: Introductionmentioning

confidence: 99%

Bevacizumab Alone or in Combination with Irinotecan in Recurrent WHO Grade II and Grade III Gliomas

et al. 2012

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Background: The repertoire of salvage regimens for patients with WHO grade II and III gliomas recurring or progressing after surgery, radiotherapy and temozolomide chemotherapy is limited. Based on promising response and progression-free survival (PFS) data in recurrent glioblastoma, the use of bevacizumab (BEV) has been extended to recurrent grade II/III gliomas. Methods: We retrospectively assessed the safety and efficacy of BEV alone or combined with irinotecan in 39 patients with recurrent grade II/III gliomas. Results: Both BEV monotherapy and its combination with irinotecan were well tolerated. Response rates were 26% as monotherapy and 33% in combination using Macdonald and RANO criteria. The median PFS was 4.2 months and the PFS rate at 6 months 29% for BEV alone, and 4.7 months and 42% for the combination. The median overall survival was 14.8 months for BEV monotherapy and 8.1 months for the combination. Outcome after failure of BEV was better when patients continued BEV beyond progression. Conclusion: BEV has limited activity in recurrent grade II/III gliomas. The additional value of irinotecan remains questionable. Prospective studies with BEV-free control groups are required to better define the role of BEV among the limited options in patients with recurrent grade II/III gliomas.

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“…Several reports have demonstrated bevacizumab's effectiveness against radiation necrosis induced by capillary permeability caused by cytokines, such as VEGF (18)(19)(20)(21). Another study demonstrated that bevacizumab had corticosteroid-sparing effects in high-grade glioma (22). These reports support a potent anti-edema effect of bevacizumab, and suggest that it may be an effective treatment option for refractory brain edema.…”

Section: Discussionmentioning

confidence: 85%

Bevacizumab for Critical Brain Metastases in a Patient with Pulmonary Pleomorphic Carcinoma

et al. 2014

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Bevacizumab was initially contraindicated in patients with brain metastases, but several reports have shown the efficacy and safety of bevacizumab for brain metastases. We herein report the case of a patient with pulmonary pleomorphic carcinoma for which bevacizumab plus weekly paclitaxel following whole-brain radiotherapy (WBRT) was effectively and safely administered for critical and refractory brain metastases. Although the 50-year-old male patient received WBRT with anti-edema therapies for progressive brain metastases, his clinical symptoms deteriorated rapidly. After the completion of WBRT, we administered bevacizumab plus weekly paclitaxel, and his neurological symptoms improved dramatically. Brain magnetic resonance imaging demonstrated a marked response by the brain metastases and improved brain edema. This case suggested both synergism between WBRT and bevacizumab, and an anti-edema effect of bevacizumab. Bevacizumab may be therefore a potent therapeutic option for patients with refractory brain metastases.

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Corticosteroid Use in Patients with Glioblastoma at First or Second Relapse Treated with Bevacizumab in the BRAIN Study

Abstract: ABSTRACT

Cited by 97 publications

References 14 publications

Drug Review: Safety and Efficacy of Bevacizumab for Glioblastoma and Other Brain Tumors

Drug Review: Safety and Efficacy of Bevacizumab for Glioblastoma and Other Brain Tumors

Bevacizumab Alone or in Combination with Irinotecan in Recurrent WHO Grade II and Grade III Gliomas

Bevacizumab for Critical Brain Metastases in a Patient with Pulmonary Pleomorphic Carcinoma

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