Patterns of relapse and prognosis after bevacizumab failure in recurrent glioblastoma

Iwamoto, Fábio M.; Abrey, Lauren E.; Beal, Kathryn; Gutin, Philip H.; Rosenblum, Marc K.; Reuter, Victor E.; DeAngelis, Lisa M.; Lassman, Andrew B.

doi:10.1212/wnl.0b013e3181bc0184

Cited by 282 publications

(237 citation statements)

References 32 publications

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“…Further, a distant recurrence was not predictive for a poor outcome compared to patients with local recurrences [27] . Comparing BEV and BEV plus CPT-11 from the BRAIN trial, [1] there was even a larger shift in the recurrence pattern from local to distant or diffuse in the BEV+ irinotecan arm as compared to BEV alone [22].…”

Section: No Shift Of Recurrence Pattern In Bev Versus Bev Plus Cpt-11mentioning

confidence: 73%

“…Further, treatment with anti-angiogenic agents nevertheless results in impressive effects on OS in animal models [8,15,27]. This allows the differential hypothesis of antiangiogenic therapy failing at the tumor-vascular interface, probably because of altered physiological, metabolic conditions in close proximity to the vessel.…”

Section: Evidence Of Increased Frequency Of Remote Relapse With Bev Tmentioning

confidence: 99%

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Patterns of Progression in Malignant Glioma Following Anti-VEGF Therapy: Perceptions and Evidence

Wick

Weiler

et al. 2011

Curr Neurol Neurosci Rep

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Antiangiogenic treatment has recently become an integral part of modern cancer therapy targeting the vasculature of numerous aggressive malignancies including glioblastoma. There is preclinical evidence that antiangiogenic therapies promote glioma cell invasiveness. In clinical series, upon progression on antiangiogenic therapy with the vascular endothelial growth factor-directed antibody bevacizumab (BEV), glioblastoma has been reported to display a more infiltrative pattern of recurrence. This distant spread at recurrence or progression and a gliomatosis cerebri-like growth pattern is best detectable on fluid-attenuated inversion recovery MRI. The frequency of up to 20% to 30% of such a pattern in BEV-treated patients is higher than expected to occur without BEV. Older reports and common clinical knowledge estimate the frequency of diffuse or distant spread in recurrent glioblastoma at 10%. This observation stimulated two streams of research. One is to overcome this often insidious adverse effect of antiangiogenic treatment, to optimize antiangiogenic therapies and to face this major challenge, integrating antiangiogenic with anti-invasive mechanisms into one combined treatment concept. The second is questioning a specific property of antiangiogenic therapy to induce diffuse or distant spread. Here, alternative hypotheses of increased awareness and better imaging as well as invasiveness being part of the natural course of the disease have been tested. Without doubt, migration and invasiveness are major obstacles to successful glioma therapy, notably local therapies, both in the natural course of the disease and in the concept of "evasive resistance." However, clinical analyses of case series, matched pairs analyses, and follow-up on the BRAIN trial (A Study to Evaluate Bevacizumab Alone or in Combination with Irinotecan for Treatment of Glioblastoma Multiforme), which led to accelerated approval of BEV for recurrent glioblastoma in the United States, have not supported a specific propensity of BEV to induce diffuse growth or distant spread at recurrence.

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Section: No Shift Of Recurrence Pattern In Bev Versus Bev Plus Cpt-11mentioning

confidence: 73%

Section: Evidence Of Increased Frequency Of Remote Relapse With Bev Tmentioning

confidence: 99%

Patterns of Progression in Malignant Glioma Following Anti-VEGF Therapy: Perceptions and Evidence

Wick

Weiler

et al. 2011

Curr Neurol Neurosci Rep

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“…However, previous serial assessments have typically considered global uptake within the tumour 1,2,4 , even though treatment failure frequently occurs locally within areas of existing abnormality 5 .…”

Section: The Editormentioning

confidence: 99%

Early Prediction of Treatment Response in Advanced Gliomas with 18F-dopa Positron-Emission Tomography

et al. 2014

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“…A preliminary study found that, when exposed to anti-angiogenic therapy, glioblastoma upregulates other pro-angiogenic factors and invades normal brain tissue through upregulation of matrix metalloproteinases, thereby shifting glioblastoma to a more infiltrative phenotype that is undetectable with enhancing mri 93,94 . Indeed, a non-enhancing pattern of tumour progression appears to be correlated with worse survival 95 . Overall, early data regarding the use of anti-angiogenic agents are promising, but additional research is needed to clarify the effects of these agents used alone or in combination with conventional chemotherapies.…”

Section: 62mentioning

confidence: 99%

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

Easaw¹,

Mason²,

Perry³

et al. 2011

Current Oncology

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Recommendation 1: Multidisciplinary Approach: To optimize treatment outcomes, the management of patients with recurrent glioblastoma should be individualized and should involve a multidisciplinary team approach, including neurosurgery, neuropathology, radiation oncology, neuro-oncology, and allied health professions. Recommendation 2: Imaging: The standard imaging modality for assessment of recurrent glioblastoma is Gd-enhanced magnetic resonance imaging (MRI). Tumour recurrence should be assessed according to the criteria set out by the Response Assessment in Neuro-Oncology Working Group. The optimal timing and frequency of MRI after chemoradiation and adjunctive therapy have not been established. Recommendation 3: Pseudo-progression: Progression observed by MRI after chemoradiation can be pseudo-progression. Accordingly, treated patients should not be classified as having progressive disease by Gd-enhancing MRI within the first 12 weeks after the end of radiotherapy unless new enhancement is observed outside the radiotherapy field or viable tumour is confirmed by pathology at the time of a required re-operation. Adjuvant temozolomide should be continued and follow-up imaging obtained. Recommendation 4: Repeat Surgery: Surgery can play a role in providing symptom relief and confirming tumour recurrence, pseudo-progression, or radiation necrosis. However, before surgical intervention, it is essential to clearly define treatment goals and the expected impact on prognosis and the patient’s quality of life. In the absence of level 1 evidence, the decision to re-operate should be made according to individual circumstances, in consultation with the multidisciplinary team and the patient. Recommendation 5: Re-irradiation: Re-irradiation is seldom recommended, but can be considered in carefully selected cases of recurrent glioblastoma. Recommendation 6: Systemic Therapy: Clinical trials, when available, should be offered to all eligible patients. In the absence of a trial, systemic therapy, including temozolomide rechallenge or antiangiogenic therapy, may be considered. Combination therapy is still experimental; optimal drug combinations and sequencing have not been established.

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Patterns of relapse and prognosis after bevacizumab failure in recurrent glioblastoma

Cited by 282 publications

References 32 publications

Patterns of Progression in Malignant Glioma Following Anti-VEGF Therapy: Perceptions and Evidence

Patterns of Progression in Malignant Glioma Following Anti-VEGF Therapy: Perceptions and Evidence

Early Prediction of Treatment Response in Advanced Gliomas with 18F-dopa Positron-Emission Tomography

Canadian Recommendations for the Treatment of Recurrent or Progressive Glioblastoma Multiforme

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