INTRODUCTION: Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), has shown promise in the treatment of patients with recurrent high-grade glioma. The purpose of this study is to test the feasibility of using bevacizumab with chemoradiation in the primary management of high-grade glioma. METHODS AND MATERIALS: Fifteen patients with high-grade glioma were treated with involved field radiation therapy to a dose of 59.4 Gy at 1.8 Gy/fraction with bevacizumab 10 mg/kg on Days 14 and 28 and temozolomide 75 mg/m(2). Subsequently, bevacizumab 10 mg/kg was continued every 2 weeks with temozolomide 150 mg/m(2) for 12 months. Changes in relative cerebral blood volume, perfusion-permeability index, and tumor volume measurement were measured to assess the therapeutic response. Immunohistochemistry for phosphorylated VEGF receptor 2 (pVEGFR2) was performed. RESULTS: Thirteen patients (86.6%) completed the planned bevacizumab and chemoradiation therapy. Four Grade III/IV nonhematologic toxicities were seen. Radiographic responses were noted in 13 of 14 assessable patients (92.8%). The pVEGFR2 staining was seen in 7 of 8 patients (87.5%) at the time of initial diagnosis. Six patients have experienced relapse, 3 at the primary site and 3 as diffuse disease. One patient showed loss of pVEGFR2 expression at relapse. One-year progression-free survival and overall survival rates were 59.3% and 86.7%, respectively. CONCLUSION: Use of antiangiogenic therapy with radiation and temozolomide in the primary management of high-grade glioma is feasible. Perfusion imaging with relative cerebral blood volume, perfusion-permeability index, and pVEGFR2 expression may be used as a potential predictor of therapeutic response. Toxicities and patterns of relapse need to be monitored closely.
INTRODUCTION:Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), has shown promise in the treatment of patients with recurrent high-grade glioma. The purpose of this study is to test the feasibility of using bevacizumab with chemoradiation in the primary management of high-grade glioma. METHODS AND MATERIALS: Fifteen patients with high-grade glioma were treated with involved field radiation therapy to a dose of 59.4 Gy at 1.8 Gy/fraction with bevacizumab 10 mg/kg on Days 14 and 28 and temozolomide 75 mg/m(2). Subsequently, bevacizumab 10 mg/kg was continued every 2 weeks with temozolomide 150 mg/m(2) for 12 months. Changes in relative cerebral blood volume, perfusion-permeability index, and tumor volume measurement were measured to assess the therapeutic response. Immunohistochemistry for phosphorylated VEGF receptor 2 (pVEGFR2) was performed. RESULTS: Thirteen patients (86.6%) completed the planned bevacizumab and chemoradiation therapy. Four Grade III/IV nonhematologic toxicities were seen. Radiographic responses were noted in 13 of 14 assessable patients (92.8%). The pVEGFR2 staining was seen in 7 of 8 patients (87.5%) at the time of initial diagnosis. Six patients have experienced relapse, 3 at the primary site and 3 as diffuse disease. One patient showed loss of pVEGFR2 expression at relapse. One-year progression-free survival and overall survival rates were 59.3% and 86.7%, respectively. CONCLUSION: Use of antiangiogenic therapy with radiation and temozolomide in the primary management of high-grade glioma is feasible. Perfusion imaging with relative cerebral blood volume, perfusion-permeability index, and pVEGFR2 expression may be used as a potential predictor of therapeutic response. Toxicities and patterns of relapse need to be monitored closely.
Authors: A K Annamalai; A F Dean; N Kandasamy; K Kovacs; H Burton; D J Halsall; A S Shaw; N M Antoun; H K Cheow; R W Kirollos; J D Pickard; H L Simpson; S J Jefferies; N G Burnet; M Gurnell Journal: Pituitary Date: 2012-09 Impact factor: 4.107
Authors: Robert B Den; Mitchell Kamrava; Zhi Sheng; Maria Werner-Wasik; Erin Dougherty; Michelle Marinucchi; Yaacov R Lawrence; Sarah Hegarty; Terry Hyslop; David W Andrews; Jon Glass; David P Friedman; Michael R Green; Kevin Camphausen; Adam P Dicker Journal: Int J Radiat Oncol Biol Phys Date: 2012-06-09 Impact factor: 7.038
Authors: Emmanuelle di Tomaso; Matija Snuderl; Walid S Kamoun; Dan G Duda; Pavan K Auluck; Ladan Fazlollahi; Ovidiu C Andronesi; Matthew P Frosch; Patrick Y Wen; Scott R Plotkin; E Tessa Hedley-Whyte; A Gregory Sorensen; Tracy T Batchelor; Rakesh K Jain Journal: Cancer Res Date: 2011-01-01 Impact factor: 12.701
Authors: Sridharan Gururangan; Susan N Chi; Tina Young Poussaint; Arzu Onar-Thomas; Richard J Gilbertson; Sridhar Vajapeyam; Henry S Friedman; Roger J Packer; Brian N Rood; James M Boyett; Larry E Kun Journal: J Clin Oncol Date: 2010-05-17 Impact factor: 44.544
Authors: Roy G Torcuator; Ravneet Thind; Mehul Patel; Y S Mohan; Joseph Anderson; Thomas Doyle; Samuel Ryu; Rajan Jain; Lonni Schultz; Mark Rosenblum; Tom Mikkelsen Journal: J Neurooncol Date: 2009-10-17 Impact factor: 4.130