Efficacy and safety of bevacizumab in active brain metastases from non-small cell lung cancer

Braganca, Kevin C. De; Janjigian, Yelena Y.; Azzoli, Christopher G.; Kris, Mark G.; Pietanza, M. Catherine; Nolan, Craig; Omuro, Antonio; Holodny, Andrei I.; Lassman, Andrew B.

doi:10.1007/s11060-010-0200-2

Cited by 94 publications

(59 citation statements)

References 14 publications

(17 reference statements)

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“…The PASSPORT study of patients with non-small lung cell carcinoma (NSCLC) and nonprogressive brain metastases after RT demonstrated that bevacizumab in addition to chemotherapeutic agents or erlotinib did not induce grade 2 ICH and that bevacizumab can be safely used in patients with brain metastases (56). A small series of patients with progressive brain metastases who failed on RT or surgery plus RT and received treatment with bevacizumab with or without chemotherapeutic agents were reported for breast cancer (57,58), NSCLC (59) and colorectal cancer (60). The ORR of the studies was 33 -100%, and the PFS and OS of patients with breast cancer and brain metastases were 2.8 -9 and 7.8 months, respectively.…”

Section: Brain Metastasesmentioning

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: Brain Metastasesmentioning

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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“…Corticosteroids are widely used for the treatment of brain cancer because they provide relief from symptoms related to intracranial pressure and edema, but their constant use is associated with potentially serious side effects. VEGF receptor inhibitors, due to their antiedema properties, have been investigated as an alternative therapy, firstly in glioblastoma [11] and then in brain metastases [12]. …”

Section: Discussionmentioning

confidence: 99%

Bevacizumab-Based Therapy for Patients with Brain Metastases from Non-Small-Cell Lung Cancer: Preliminary Results

et al. 2014

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Background: Bevacizumab is a recombinant humanized monoclonal antibody that obstructs the vascular endothelial growth factor (VEGF) pathway.Despite its extensive employment in the treatment of primary tumors of the brain, experience of brain metastatic disease, a frequent complication in patients with lung cancer, is very limited. On the basis of the strong antiedemigenous effect and no risk of intracranial bleeding, we administered a bevacizumab-based chemotherapy to patients with non-small-cell lung cancer (NSCLC) and symptomatic metastatic brain lesions who were not suitable candidates for a specific local therapy. Methods: The patients received bevacizumab 7.5 mg/kg and cisplatin 75 mg/m² on day 1, and gemcitabine 1,250 mg/m² on days 1 and 8, every 21 days. Results: We studied 13 patients with clinical and radiological progressive brain metastases; the majority had a treatment-naïve disease. Bevacizumab-based chemotherapy was found to be well tolerated and effective: progression-free survival (PFS) was 9.1 months (range: 0.9-39.2+) and overall survival (OS) was 9.6 months (range 3-41.5+). Conclusions: Bevacizumab-based therapy proved to be feasible and safe. The PFS and the OS data are very encouraging as well as the symptomatic benefit due to bevacizumab's high capacity to provide a long-lasting decrease of perilesional edema.

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“…Best CNS response, was partial in two, stable disease in three, and progression in one patient. Improvement in symptoms and reduction in corticosteroid requirements was reported (37).…”

Section: Angiogenesis In Brain Metastasesmentioning

confidence: 98%

Anti-angiogenetic therapies for central nervous system metastases from non-small cell lung cancer

Buttigliero

Bertaglia

Novello

2016

Transl. Lung Cancer Res.

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Central nervous system (CNS) metastases are common in patients with advanced non-small cell lung cancer (NSCLC), occurring in 24% to 44% of patients in the course of their disease and confer significant morbidity and mortality. Systemic therapies have been deemed ineffective in brain metastases (BM) under the hypothesis that the blood-brain barrier (BBB) limits their delivery to the brain. Angiogenesis, which is mainly mediated by vascular endothelial growth factor (VEGF) pathway, is crucial for tumor survival, growth and invasion both in primary and metastatic brain lesions. Two major categories of agents have been developed to target this pathway: antibody-based agents and VEGF receptor tyrosine kinase inhibitors (TKIs). Clinical benefits have been shown with anti-angiogenetic therapies in the treatment of metastatic NSCLC. However, patients with CNS metastases were often excluded from trials with these agents, due to concerns about a potentially greater risk of cerebral haemorrhage and thromboembolic disease. Therefore, the overall efficacy and safety of angiogenetic agents in patients with BM from NSCLC are yet to be clarified. This paper aims to review available data about the efficacy and safety of antiangiogenetic therapies for CNS metastases in NSCLC patients.

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Efficacy and safety of bevacizumab in active brain metastases from non-small cell lung cancer

Cited by 94 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-Based Therapy for Patients with Brain Metastases from Non-Small-Cell Lung Cancer: Preliminary Results

Anti-angiogenetic therapies for central nervous system metastases from non-small cell lung cancer

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