DECEMBER 15, 2007


At last, a decent Tx for deadliest
brain tumours

Bevacizumab plus radiation triples high-grade glioma patient survival

A drug that triples survival rate for high-grade gliomas is safe enough to become the firstline therapy for this nearly impossible-to-treat cancer. Bevacizumab, an anti-angiogenesis drug that's used for colorectal and other cancers, is safe and effective when used with chemo and radiation, New York University oncologist Dr Ashwatha Narayana told delegates at the annual meeting of the American Society for Therapeutic Radiology and Oncology in November in Los Angeles.

"We're very excited that, for the very first time in over three years, we're making any kind of progress in treating this cancer, which has a two-year survival rate of hardly 5%," Dr Narayana told NRM. He hopes the study will lead the FDA to approve bevacizumab as a frontline management for high-grade gliomas. These malignant brain tumours are incurable and recur in almost all patients within a year of treatment. "Even in a recurrent setting, we're showing that we can improve the survival for these patients and increase their quality of life," adds Dr Narayana.

In Dr Narayana's study, which appeared in a supplement of the International Journal of Radiation Oncology Biology Physics in November, 14 high-grade glioma patients (three recurrent and 11 biopsy only) were treated with radiation therapy, chemo drug temozolomide and bevacizumab. Changes in relative cerebral blood volume, perfusion-permeability index and tumour volume were measured to assess the therapeutic response.

After six months, only four of the 14 patients had a cancer relapse, three of them at the primary site, where the tumour was first detected, and one of them at a different site. The latter patient succumbed to the disease. The six month progression-free survival and overall survival were 71% and 92%, respectively — nearly triple the expected survival with this cancer. Side effects were relatively minor and did not include cerebral hemorrhaging, which is a risk with bevacizumab.

"We're cautiously optimistic," says Dr Narayana. His team showed that bevacizumab diminished tumour recurrence at the primary site and enhanced the effect of chemo and radiation therapies. But in patients where the cancer recurred, it cropped up in a different part of the brain. "This isn't the usual pattern of failure, which leaves us somewhat concerned," he adds.

In attempting to use the drug to treat gliomas, Dr Narayana says he's trying to decide where to draw the line between its effectiveness and complications. "Essentially, what is the optimal dose? Do we have to hold back radiation when administering bevacizumab, and what is the best timing for treatment — before, concurrent or after? Do we continue a patient on anti-angiogenic treatment after they're stopped radiation therapy? There are still a lot more questions than answers," he says.



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