&lt;p&gt;Ultra-Low-Dose Bevacizumab For Cerebral Radiation Necrosis: A Prospective Phase II Clinical Study&lt;/p&gt;

Zhuang, Hongqing; Zhuang, Hongqin; Shi, Siyu; Wang, Yuxia

doi:10.2147/ott.s223258

Cited by 21 publications

(66 citation statements)

References 30 publications

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“…Overall, two prospective studies, seven retrospective studies, and three case reports involving 89 patients with RN treated with BV were obtained following the research strategy and study selection process [33,[48][49][50][51][52][53][54][55][56][57][58]. The PRISMA flow diagram for the same is illustrated in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Bevacizumab (BV) has also made it a treatment paradigm for RN [28][29][30]. Recent clinical trials have shown encouraging results [31][32][33].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported the efficacy of BV in the treatment of RN diagnosed in primary brain tumor, metastatic, and patients with nasopharyngeal carcinoma (NPC) [31][32][33][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Two randomized controlled trials have shown its efficacy over placebo or corticosteroid-receiving patients, without any increase in toxicity in primary brain tumors and NPC patients [31,32].…”

Section: Introductionmentioning

confidence: 99%

“…Two randomized controlled trials have shown its efficacy over placebo or corticosteroid-receiving patients, without any increase in toxicity in primary brain tumors and NPC patients [31,32]. Recently, a prospective phase II clinical trial has revealed efficacy of BV in patients with metastatic brain disease who have RN [33]. However, the majority of studies had included patients without differentiating for their intracranial disease type [50][51][52][53][54].…”

Section: Introductionmentioning

confidence: 99%

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Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

et al. 2021

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Background Radiotherapy is the mainstay of brain metastasis (BM) management. Radiation necrosis (RN) is a serious complication of radiotherapy. Bevacizumab (BV), an anti-vascular endothelial growth factor monoclonal antibody, has been increasingly used for RN treatment. We systematically reviewed the medical literature for studies reporting the efficacy and safety of bevacizumab for treatment of RN in BM patients. Materials and methods PubMed, Medline, EMBASE, and Cochrane library were searched with various search keywords such as “bevacizumab” OR “anti-VEGF monoclonal antibody” AND “radiation necrosis” OR “radiation-induced brain necrosis” OR “RN” OR “RBN” AND “Brain metastases” OR “BM” until 1st Aug 2020. Studies reporting the efficacy and safety of BV treatment for BM patients with RN were retrieved. Study selection and data extraction were carried out by independent investigators. Open Meta Analyst software was used as a random effects model for meta-analysis to obtain mean reduction rates. Results Two prospective, seven retrospective, and three case report studies involving 89 patients with RN treated with BV were included in this systematic review and meta-analysis. In total, 83 (93%) patients had a recorded radiographic response to BV therapy, and six (6.7%) had experienced progressive disease. Seven studies (n = 73) reported mean volume reductions on gadolinium-enhanced T1 (mean: 47.03%, +/− 24.4) and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI images (mean: 61.9%, +/− 23.3). Pooling together the T1 and T2 MRI reduction rates by random effects model revealed a mean of 48.58 (95% CI: 38.32–58.85) for T1 reduction rate and 62.017 (95% CI: 52.235–71.799) for T2W imaging studies. Eighty-five patients presented with neurological symptoms. After BV treatment, nine (10%) had stable symptoms, 39 (48%) had improved, and 34 (40%) patients had complete resolution of their symptoms. Individual patient data was available for 54 patients. Dexamethasone discontinuation or reduction in dosage was observed in 30 (97%) of 31 patients who had recorded dosage before and after BV treatment. Side effects were mild. Conclusions Bevacizumab presents a promising treatment strategy for patients with RN and brain metastatic disease. Radiographic response and clinical improvement was observed without any serious adverse events. Further class I evidence would be required to establish a bevacizumab recommendation in this group of patients.

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Section: Resultsmentioning

confidence: 99%

“…Bevacizumab (BV) has also made it a treatment paradigm for RN [28][29][30]. Recent clinical trials have shown encouraging results [31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

et al. 2021

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“…One option would be to further lower the dose of bevacizumab but keep the continuous administration. This approach of lowering the dose to 1 mg/kg bevacizumab every three weeks has revealed promising results in a phase 2 trial [ 19 ]. The trial included 21 patients and the grade of the edema index was improved in 19 patients.…”

Section: Discussionmentioning

confidence: 99%

Single-shot bevacizumab for cerebral radiation injury

et al. 2021

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Background Cerebral radiation injury, including subacute radiation reactions and later stage radiation necrosis, is a severe side effect of brain tumor radiotherapy. A protocol of four infusions of the monoclonal antibody bevacizumab has been shown to be a highly effective treatment. However, bevacizumab is costly and can cause severe complications including thrombosis, bleeding and gastrointestinal perforations. Methods We performed a retrospective analysis of patients treated in our clinic for cerebral radiation injury who received only a singular treatment with bevacizumab. Single-shot was defined as a singular administration of bevacizumab without a second administration during an interval of at least 6 weeks. Results We identified 11 patients who had received a singular administration of bevacizumab to treat cerebral radiation injury. Prior radiation had been administered to treat gliomas (ten patients) or breast cancer brain metastases (one patient). 9 of 10 patients with available MRIs showed a marked reduction of edema at first follow-up. Discontinuation of Dexamethasone was possible in 6 patients and a significant dose reduction could be achieved in all other patients. One patient developed pulmonary artery embolism 2 months after bevacizumab administration. The median time to treatment failure of any cause was 3 months. Conclusions Single-shot bevacizumab therefore has meaningful activity in cerebral radiation injury, but durable control is rarely achieved. In patients where a complete protocol of four infusions with bevacizumab is not feasible due to medical contraindications or lack of reimbursement, single-shot bevacizumab treatment may be considered.

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DEGRO practical guideline for central nervous system radiation necrosis part 2: treatment

Bernhardt

König²,

Grosu³

et al. 2022

Strahlenther Onkol

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Purpose The Working Group for Neurooncology of the German Society for Radiation Oncology (DEGRO; AG NRO) in cooperation with members of the Neurooncological Working Group of the German Cancer Society (DKG-NOA) aimed to define a practical guideline for the diagnosis and treatment of radiation-induced necrosis (RN) of the central nervous system (CNS). Methods Panel members of the DEGRO working group invited experts, participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for medical treatment of RN, including bevacizumab, in clinical routine. Conclusion Diagnosis and treatment of RN requires multidisciplinary structures of care and defined processes. Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neurooncologist. If the diagnosis of blood–brain barrier disruptions (BBD) or RN is likely, treatment should be initiated depending on the symptoms, location, and dynamic of the lesion. Multiple treatment options are available (such as observation, surgery, steroids, and bevacizumab) and the optimal approach should be discussed in an interdisciplinary setting. In this practice guideline, we offer detailed treatment strategies for various scenarios.

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<p>Ultra-Low-Dose Bevacizumab For Cerebral Radiation Necrosis: A Prospective Phase II Clinical Study</p>

Cited by 21 publications

References 30 publications

Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

Single-shot bevacizumab for cerebral radiation injury

DEGRO practical guideline for central nervous system radiation necrosis part 2: treatment

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